Exclusive human milk feeding for the first 6 months of life, with continued breastfeeding for 1 to 2 years

of life or longer, is recognized as the normative standard for infant feeding.1,2 (Breastfeeding and the use
of human milk.Section on Breastfeeding.Pediatrics. 2012 Mar; 129(3):e827-41; WHO . Infant and young
child nutrition. Geneva: 2003)

Human milk is uniquely suited to the human infant, both in its nutritional composition and in the non-
nutritive bioactive factors that promote survival and healthy development(The evolution of milk secretion
and its ancient origins.Oftedal OT Animal. 2012 Mar; 6(3):355-68)

The first fluid produced by mothers after delivery is colostrum, which is distinct in volume, appearance
and composition. Colostrum, produced in low quantities in the first few days postpartum, is rich in
immunologic components such as secretory IgA, lactoferrin, leukocytes, as well as developmental factors
such as epidermal growth factor.( Premature delivery influences the immunological composition of
colostrum and transitional and mature human milk.Castellote C, Casillas R, Ramírez-Santana C, Pérez-
Cano FJ, Castell M, Moretones MG, López-Sabater MC, Franch AJ Nutr. 2011 Jun; 141(6):1181-7.)

Colostrum also contains relatively low concentrations of lactose, indicating its primary functions to be
immunologic and trophic rather than nutritional. Levels of sodium, chloride and magnesium are higher
and levels of potassium and calcium are lower in colostrum than later milk(Initiation of human lactation:
secretory differentiation and secretory activation.Pang WW, Hartmann PEJ Mammary Gland Biol
Neoplasia. 2007 Dec; 12(4):211-21.)

Transitional milk shares some of the characteristics of colostrum but represents a period of “ramped up”
milk production to support the nutritional and developmental needs of the rapidly growing infant, and
typically occurs from 5 days to two weeks postpartum, after which milk is considered largely mature. By
four to six weeks postpartum, human milk is considered fully mature. In contrast to the dramatic shift in
composition observed in the first month of life, human milk remains relatively similar in composition,
although subtle changes in milk composition do occur over the course of lactation.( Author manuscript; available
in PMC 2014 Feb 1.

Published in final edited form as:

Pediatr Clin North Am. 2013 Feb; 60(1): 49–74.

doi: 10.1016/j.pcl.2012.10.002

PMCID: PMC3586783

NIHMSID: NIHMS413874

Human Milk Composition: Nutrients and Bioactive

Factors
Olivia Ballard, JD, PhD (candidate) and Ardythe L. Morrow, PhD, MSc

)
The proteins of human milk are divided into the whey and casein fractions or complexes, with each
comprised by a remarkable array of specific proteins and peptides (Proteomic characterization of human
milk whey proteins during a twelve-month lactation period.Liao Y, Alvarado R, Phinney B, Lönnerdal BJ
Proteome Res. 2011 Apr 1; 10(4):1746-54.;Temporal changes in milk proteomes reveal developing milk
functions.Gao X, McMahon RJ, Woo JG, Davidson BS, Morrow AL, Zhang QJ Proteome Res. 2012 Jul 6;
11(7):3897-907.)

The most abundant proteins are casein, α-lactalbumin, lactoferrin, secretory immunoglobulin IgA,
lysozyme, and serum albumin.( Human milk proteins: key components for the biological activity of human
milk; Jensen RG. Handbook of Milk Composition. Academic Press, Inc.; San Diego, CA: 1995)

The protein content of milk obtained from mothers who deliver preterm is significantly higher than that
of mothers who deliver at term (Table 1). Protein levels decrease in human milk over the first 4 to 6 weeks
or more of life regardless of timing of delivery (Figure 1).( Longitudinal analysis of macronutrients and
minerals in human milk produced by mothers of preterm infants.Bauer J, Gerss J Clin Nutr. 2011 Apr;
30(2):215-20.)

Human milk protein concentration is not affected by maternal diet, but increases with maternal body
weight for height, and decreases in mothers producing higher amounts of milk.( Determinants of energy,
protein, lipid, and lactose concentrations in human milk during the first 12 mo of lactation: the DARLING
Study.Nommsen LA, Lovelady CA, Heinig MJ, Lönnerdal B, Dewey KGAm J Clin Nutr. 1991 Feb; 53(2):457-
65.)

Feeding human milk protects against infection and inflammation,86 (Modulation of the gastrointestinal tract
of infants by human milk. Interfaces and interactions. An evolutionary perspective.Goldman AS

J Nutr. 2000 Feb; 130(2S Suppl):426S-431S.) and early milk is enriched in immune factors that help to
ensure infant survival.( Temporal changes in milk proteomes reveal developing milk functions.Gao X,
McMahon RJ, Woo JG, Davidson BS, Morrow AL, Zhang QJ Proteome Res. 2012 Jul 6; 11(7):3897-907.)15

A recent study in Nepal found a 9-fold increase in risk of diarrhea in children who were not
breastfed,122 (Risk factors for extended duration of acute diarrhea in young children.
Strand TA, Sharma PR, Gjessing HK, Ulak M, Chandyo RK, Adhikari RK, Sommerfelt H
PLoS One. 2012; 7(5):e36436. )consistent with previous global studies.123 (Breastfeeding and the risk for
diarrhea morbidity and mortality.Lamberti LM, Fischer Walker CL, Noiman A, Victora C, Black RE

BMC Public Health. 2011 Apr 13; 11 Suppl 3():S15.)Infants are born with immature acquired immunity,
and rely on maternal antibodies for defense against pathogens.124 (The mucosal immune system and its
integration with the mammary glands.Brandtzaeg PJ Pediatr. 2010 Feb; 156(2 Suppl):S8-15.) Human milk
sIgA-antigen complexes are taken up and processed by intestinal dendritic cells, which allows for antigen
recognition while maintaining a non-inflammatory environment.125 (Secretory IgA mediates bacterial
translocation to dendritic cells in mouse Peyer's patches with restriction to mucosal compartment.Kadaoui
KA, Corthésy BJ Immunol. 2007 Dec 1; 179(11):7751-7.) While sIgA is the predominant antibody of human
milk, milk also contains IgM and IgG, the latter becoming more abundant in later lactation.15 (Temporal
changes in milk proteomes reveal developing milk functions.Gao X, McMahon RJ, Woo JG, Davidson BS,
Morrow AL, Zhang QJ Proteome Res. 2012 Jul 6; 11(7):3897-907.

)A comprehensive review of human milk immunoglobulins is available elsewhere.124,126,127

A complete understanding of the possible functions of human milk proteins has been limited by incomplete
knowledge of the human milk proteome. In this report, we have analyzed the proteomes of whey from
human transitional and mature milk using ion-exchange and SDS-PAGE based protein fractionation
methods. With a larger-than-normal sample loading approach, we are able to largely extend human milk
proteome to 976 proteins. Among them, 152 proteins are found to render significant regulatory changes
between transitional milk and mature milk. We further found that immunoglobulins sIgA and IgM are more
abundant in transitional milk, whereas IgG is more abundant in mature milk, suggesting a transformation in
defense mechanism from newborns to young infants.( J Proteome Res. 2012 Jul 6;11(7):3897-907. doi:
10.1021/pr3004002. Epub 2012 Jun 21.

Temporal changes in milk proteomes reveal developing

milk functions.Gao X , McMahon RJ, Woo JG, Davidson BS, Morrow AL, Zhang Q.)
1

Transitional milk
Transitional milk occurs after colostrum and lasts for
approximately two weeks. The content of transitional milk
includes high levels of fat, lactose, and water-soluble
vitamins. It contains more calories than colostrum.

Mature milk
Mature milk is the final milk that is produced. 90% of it is
water, which is necessary to keep the infant hydrated. The other
10% is comprised of carbohydrates, proteins, and fats which are
necessary for both growth and energy.
(American pregnancy association, 2017)