Development of a biochemical marker to detect current breast milk intake

Addison, R., Hill, L., Bode, L., Robertson, B., Choudhury, B., Young, D., Wright, C. , Relton, C., Garcia, A. L. and Tappin, D. M. (2020) Development of a biochemical marker to detect current breast milk intake. Maternal and Child Nutrition, 16(1), e12859. (doi: 10.1111/mcn.12859) (PMID:31216094)

Abstract

The WHO recommends exclusive breastfeeding for 6 months, but despite interventions, breastfeeding rates remain stubbornly low. Financial voucher incentives have shown promise but require a biomarker for validation of intake. This study aimed to develop a simple biochemical assay of infant urine that would tell if an infant was receiving any breast milk to validate maternal report. Urine samples were collected and snap frozen from 34 infants attending with minor illness or feeding problems, of whom 12 infants were exclusively breastfed, nine exclusively formula fed, and 11 mixed breast/formula fed. High‐performance anion exchange chromatography was used to identify discriminating patterns of monosaccharide composition of unconjugated glycans in a sequence of three experiments. The absolute concentration of all human milk oligosaccharides measured blind could detect “any breastfeeding” only with a sensitivity of 48% and specificity of 78%. Unblinded examination of N‐acetylglucosamine (GlcNAc) measured as GlcNH2 after hydrolysis of GlcNAc improved sensitivity to 75% at the expense of a specificity of 28%. Estimation of the relative abundance of GlcNH2 (GlcNH2[%]) or the ratio of GlcNH2 to endogenous mannose (Man) improved accuracy. In a further blind experiment, the GlcNH2/Man ratio with a cut‐off of 1.5 correctly identified all those receiving “any breast milk,” while excluding exclusively formula fed infants. The GlcNH2/Man ratio in infant urine is a promising test to provide biochemical confirmation of any breastfeeding for trials of breastfeeding promotion.

• Item Type: Articles
• Additional Information: Funding for this study was given by the NOSH study (the Medical Research Council 62 (MR/J000434/1) via the National Prevention Research Initiative Phase 4 Awards), 63 and by The Feeding Research Fund in Glasgow.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Tappin, Professor David and Wright, Professor Charlotte and Garcia, Dr Ada
• Authors: Addison, R., Hill, L., Bode, L., Robertson, B., Choudhury, B., Young, D., Wright, C., Relton, C., Garcia, A. L., and Tappin, D. M.
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Maternal and Child Nutrition
• Publisher: Wiley
• ISSN: 1740-8695
• ISSN (Online): 1740-8709
• Published Online: 19 June 2019
• Copyright Holders: Copyright © 2019 The Authors
• First Published: First published in Maternal and Child Nutrition 16(1):e12859
• Publisher Policy: Reproduced under a Creative Commons License