Most babies in Denmark are well-nourished, and they grow and develop as they should. But unfortunately this isn’t the same for all countries. Children in several low-income countries cannot cover their daily vitamin and mineral needs, and this can negatively affect their health and development. According to an article in The Lancet, it has been estimated that up to 823,000 children could be saved from dying every year, if breast-feeding in the first year could be optimised globally.
In a new research project, the University of Copenhagen, in collaboration with researchers from Bangladesh, Brazil, Gambia and the US, is investigating the content of vitamins, minerals and other important components in breast milk in order to develop international reference values for breast milk and to examine more closely the impact of the composition of milk on children’s growth and well-being.
"We need to know more about the optimum composition of breast milk in order to determine whether some population groups in low-income countries need to improve mothers’ diets while they’re breast-feeding," said Kim Fleischer Michaelsen, professor of child nutrition at the Department of Nutrition, Exercise and Sports at the University of Copenhagen, who is heading the Danish part of the project.
Denmark has been chosen because a higher percentage of Danish mothers breast-feed their babies compared with many other high-income countries such as the UK and the US. Danish breast-feeding mothers are generally in good health and consume the recommended daily amount of vitamins and minerals, so the majority of babies in Denmark are also healthy and well-nourished. Therefore, Denmark is an interesting positive example of what concentration of vitamins and minerals in breast milk is required to give babies healthy growth and well-being.
Approximately 250 pregnant women from Rigshospitalet have been included in the project. Dr Kristina Renault, a senior house officer, with Ane Rom and Kristel Guldhaugen, both midwives from the Department of Obstetrics are involved in the project, and are helping with recruitment as well as scientific work. The women taking part in the project will have access to a special advisor on breast-feeding who has been employed to help the women breast-feed. They will also receive guidance on nutrition.
Women will be linked to the project before their third trimester, and they will be monitored until their child is about nine-months old. Over this period, the mothers and babies will be invited to three 1½-hour-long examinations at the University of Copenhagen, during which they will be asked to submit urine and faecal samples, they will have blood samples taken and they will be measured and weighed. The women will also be asked to submit milk samples and complete diet charts. In order to participate in the project, the women will have to breast-feed their babies exclusively for 3.5 months, and partly for 8.5 months.
"Much of the previous research on breast-feeding is about how long mothers breast-feed, and what it means for the child, but the content of the breast milk has not been examined," explained Dr Kristina Renault. "We believe there’s a big difference between the content of breast milk from a Danish woman compared with milk from a Gambian woman, but we don’t actually know," she explained. "We do know from a PhD project that virtually all women in Gambia successfully breast-feed their babies," said Kristina. "Perhaps we could learn something from them in Denmark," she said.
The breast milk will be examined in detail at the Department of Nutrition, Exercise and Sports at the University of Copenhagen, and in the US, to ascertain the optimal composition in terms of nutrients, minerals and vitamins. This will help determine the optimal diet for a breast-feeding woman and what dietary supplements a woman from a low-income country could possibly benefit from.
Kristina Renault and Ane Rome have also decided to supplement the MILQ project with a research project focussing on the Danish women and their ability to breast-feed successfully. "We’ve written a supplementary protocol in which we want to examine mothers’ insulin resistance and the possible significance of metabolic factors for breast-feeding and the child's growth and development," explained Kristina Renault. Therefore, as part of the study, Rigshospitalet will prepare a glucose tolerance test, measure the blood sugar, and take a blood sample from the mothers participating from Rigshospitalet.
"One of the things we’re particularly interested in studying," explained Kristina Renault, "is whether inflammatory and metabolic factors can help predict which of the women will not be able to breast-feed successfully, and who therefore will need special attention during their pregnancy and after childbirth. This will enable us to intervene earlier and help more women to breast-feed successfully.
This is the first study in Denmark to examine the composition of breast milk in so much detail and for such a large group of mothers. The project will generate important knowledge for future prevention and treatment of incorrect nutrition and malnutrition in children in low-income countries. Both Rigshospitalet and Hvidovre Hospital are helping recruit pregnant women to the project.
Read more about the project and sign up as a pregnant subject for the project (in Danish):
MILQ stands for Mothers, Infants and Lactation Quality. The project started in September 2017 and is expected to be completed in 2019.