EFSA supporting publication 2014:EN-629
EXTERNAL SCIENTIFIC REPORT
Comprehensive literature search and review of breast milk composition as
preparatory work for the setting of dietary reference values for vitamins
and minerals1
LASER Analytica
ABSTRACT
This work summarises the outcome of a comprehensive literature search on the breast milk concentrations of
folate, zinc, vitamin B6, vitamin E, choline, phosphorus, potassium, vitamin A, vitamin B1, chloride, sodium,
copper and magnesium in healthy women from Europe, North America and Australia published from January
2000 for folate, zinc, vitamin B6, vitamin E, choline, phosphorus, vitamin A, vitamin B1, chloride and sodium,
from October 2010 for potassium and magnesium and from January 2011 for copper. The results present ranges
of concentrations reported for the general population of healthy nursing women. Where appropriate, separate
results are presented according to the stages of lactation, the gestational age at birth (i.e., milk from mothers of
term vs. pre-term infants), and the use or not of a supplement containing the micronutrient of interest. When
assessed, data on the relationships between dietary intake (including the effect of supplementation) or status of
the micronutrient of interest and breast milk concentration are presented.
© LASER Analytica, 2014
KEY WORDS
breast milk, vitamins, minerals
DISCLAIMER
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried
out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the author(s),
awarded following a tender procedure. The present document is published complying with the transparency principle to
which the Authority is subject. It may not be considered as an output adopted by the Authority. The European Food Safety
Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present
document, without prejudice to the rights of the authors.
1
Question No EFSA-Q-2013-01027.
Any enquiries related to this output should be addressed to [email protected]
Suggested citation: LASER Analytica, 2014. Comprehensive literature search and review of breast milk composition as
preparatory work for the setting of dietary reference values for vitamins and minerals. EFSA supporting publication
2014:EN-629, 154 pp.
Available online: www.efsa.europa.eu/publications
© European Food Safety Authority, 2014
Vitamin and mineral content of breast milk
SUMMARY
Several comprehensive literature searches have been performed to record all data available on breast
milk concentrations of folate, zinc, vitamin B6, vitamin E, choline, phosphorus, potassium, vitamin A,
vitamin B1, chloride, sodium, copper and magnesium in healthy women from Europe, North America
and Australia according to specific time periods. Studies included in the review where those published
from January 2000 for folate, zinc, vitamin B6, vitamin E, choline, phosphorus, vitamin A, vitamin
B1, chloride and sodium, those published from October 2010 for potassium and magnesium and those
published from January 2011 for copper.
Besides the provision of major findings for each included study in tables, a qualitative critical
appraisal was performed. Criteria considered were confounding factors associated with the
characteristics of the study population (details on the supplementation or not, health status) and milk
samples (stage of lactation, i.e., colostrum, transitional milk, mature milk). Reliability/usefulness of
analytical methods applied was also assessed for each study individually according to the presence of
quality controls (standard reference materials) and sufficient details on the validation of the analytical
method applied (i.e., recovery, repeatability, limit of detection (LOD), limit of quantification (LOQ)).
The results were pooled in order to present weighted means and 95 % confidence intervals (CIs) for
the general population of healthy nursing women (i.e., all milk samples included) and specific
subgroups (according to the stages of lactation for mothers of term infants, the gestational age at birth
(i.e., milk from mothers of term vs. pre-term infants), and the use or not of a supplement containing
the micronutrient of interest). When assessed, data on the relationships between dietary intake
(including the effect of supplementation) or status of the micronutrient of interest and breast milk
concentration are presented.
The comprehensive literature searches on folate concentration in human breast milk retrieved 8
relevant studies. Two studies were free of confounders. When reported, the analytical method used for
folate analysis was mainly high performance liquid chromatography–mass spectrometry (HPLCMS/MS, 4 studies). Microbiological assays were also used (3 studies). One study did not report the
analytical method for folate. Forms of folate analysed were total folate (reduced forms of folic acid,
including tetrahydrofolate (H4-folate) and 5-methyltetrahydrofolate (5-CH3-H4 folate), 7 studies), folic
acid (2 studies), 5-CH3-H4 folate (2 studies), H4-folate (1 study), and the catabolites paminobenzoylglutamate and acetamide-p-aminobenzoylglutamate (1 study). The weighted mean (95%
CI) folate concentration from all samples was 57.3 (52.6 – 62.0) µg/L. Three studies involved mothers
of term infants, all of those were performed on mature milk samples (weighted mean (95% CI): 52.7
(45.0 – 63.0) µg/L). Regarding the relationship between folate intake/status and breast milk
concentration, two studies found no association between folic acid supplementation and total folate
concentration in breast milk. A third study found a relationship between folic acid concentration in
breast milk and folate intake, but not between total folate concentration in breast milk and folate
intake. Women supplemented with folic acid presented breast milk concentrations of total folate of
(weighted mean (95% CI)) 60.4 (54.8 – 65.9) µg/L; those not supplemented presented breast milk
concentrations of total folate of (weighted mean (95% CI)) 48.7 (39.6 – 57.8) µg/L.
Forty-one studies, reported in 42 papers, reported zinc concentrations in breast milk. Six studies were
free of confounders. For zinc determination, the analytical method used was mainly atomic absorption
spectrometry (25 studies); ICP-MS was used in 6 studies; voltammetry was used in 1 study. Ten
studies did not report the analytical method for zinc. The weighted mean (95% CI) zinc concentration
from all samples was 2.06 (2.05 – 2.07) mg/L. Colostrum contained high zinc concentrations
(weighted mean (95% CI): 8.60 (5.03 – 12.17) mg/L); zinc concentrations were lower for transitional
milk (weighted mean (95% CI): 2.72 (2.33 – 3.11) mg/L) and mature milk (weighted mean (95% CI):
1.48 (1.46 – 1.51) mg/L). Milk samples were collected from mothers who gave birth to both term and
pre-term infants. Mothers of term infants presented a 5-fold higher breast milk zinc concentration
EFSA supporting publication 2014:EN-629
2
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively
by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender
procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be
considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the
issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
(weighted mean (95% CI): 2.51 (2.32 – 2.71) mg/L) than mothers of preterm infants (weighted mean
(95% CI): 0.47 (0.39 – 0.55) mg/L). Two studies showed no significant correlation between milk zinc
concentration and maternal plasma zinc. Another study found no relationship between zinc dietary
intake and breast milk concentration.
Four studies reported concentration of total vitamin B6 (2 studies) or individual forms of vitamin B6
(pyridoxal, pyridoxine, pyridoxamine) (2 studies) in breast milk. Three studies were free of
confounders. Total vitamin B6 was measured via microbiological assays (2 studies); pyridoxal (2
studies), pyridoxamine (1 study) and pyridoxine (1 study) were measured via HPLC-MS/MS. The 2
studies dealing with total vitamin B6 concentration involved supplemented mothers of term infants, all
of those were performed on mature milk samples. The weighted mean (95% CI) for total vitamin B6
concentration for these two studies was 244 (232 – 256) µg/L. An additional study reported total
vitamin B6 concentration as the sum of pyridoxal, pyridoxamine and pyridoxine. Women were
mothers of term infants and were mostly supplemented with undefined nutrients. The weighted mean
(95% CI) for total vitamin B6 concentration from all samples coming from these 3 studies was 233
(222 – 244) µg/L. There were no data on vitamin B6 concentration in breast milk of non-supplemented
mothers. Three studies reported intake data; only 1 reported data on status (as plasma total vitamin B6
concentration). One study reported a significant positive correlation between vitamin B6 intake and
breast milk pyridoxal concentration, while the relationship was not investigated in the 3 other studies.
Vitamin E breast milk concentration was assessed in 24 publications (23 studies) via the quantification
of alpha-tocopherol, beta-tocopherol, delta-tocopherol, gamma-tocopherol, or total vitamin E (defined
in most of cases as alpha-tocopherol + 0.25 gamma-tocopherol). Five studies were free of
confounders. The analytical method employed was HPLC-MS/MS (23 studies). Five studies reported
total vitamin E expressed as tocopherol-equivalent (TE, TE (mg) = alpha-tocopherol (mg) + 0.25
gamma-tocopherol (mg)). The weighted mean (95% CI) for TE concentration from all samples was
3.87 (3.53 – 4.22) mg/L. Weighted means (95% CIs) for TE at different stages of lactation are as
follows: transitional milk = 4.27 (0.01 – 8.54) mg/L; mature milk = 3.30 (1.09 – 5.51) mg/L. When
specified, milk samples were collected from mothers who gave birth to term infants. Mothers of term
infants presented TE concentration of 3.51 (1.54 – 5.47) mg/L. When women were supplemented with
vitamin E, weighted mean (95% CI) for TE was 3.59 (2.73 – 4.45) mg/L. Nineteen studies reported
alpha-tocopherol concentration in women milk. The weighted mean (95% CI) for alpha-tocopherol
concentration from all samples was 3.74 (3.63 – 3.85) mg/L. Weighted means (95% CIs) at different
stages of lactation were as follows: colostrum = 24.11 (13.17 – 35.05) mg/L; transitional milk = 11.86
(10.77 – 12.95) mg/L; mature milk = 3.30 (3.16 – 3.44) mg/L. Milk samples were collected from
mothers who gave birth to both term or pre-term infants. Weighted mean (95% CI) was 6.84 (5.99 –
7.69) mg/L) for breast milk of mothers of preterm infants and 3.45 (3.31 – 3.59) mg/L for breast milk
of mothers of term infants. The weighted means (95% CIs) were 8.28 (7.65 – 8.90) mg/L for milk
from non-supplemented women vs. 3.46 (2.61 – 4.32) mg/L for milk from supplemented women.
Seven studies reported intake data; 3 reported data on status (as plasmatic alpha-tocopherol
concentration, sum of plasmatic alpha- and gamma-tocopherols, or “total vitamin E” concentration
(with no precision on the tocopherol(s) considered)). Two studies showed a correlation between the
concentration of vitamin E in the milk (alpha-TE as the sum of alpha- and gamma-tocopherols) and its
intake (forms not specified, range 6 – 9 mg/day), whereas 3 other studies did not find a correlation
between breast milk vitamin E concentration (alpha-TE as the sum of alpha- and gamma-tocopherols)
and intake (forms not specified, 3.43 – 16.67 mg/day). One study failed to show a correlation between
maternal plasma alpha-tocopherol and TE (alpha- + gamma-tocopherol) milk concentrations.
Five studies dealt with choline breast milk concentration (free and/or total choline,
phosphatidylcholine, phosphocholine, glycerophosphocholine, phospholipid-bound choline). Two
studies were free of confounders. Free choline (5 studies), total choline (4 studies),
phosphatidylcholine (1 study), phosphocholine (1 study), glycerophosphocholine (1 study) and
phospholipid-bound choline (1 study) were measured via HPLC-MS/MS (2 studies), enzymatic
EFSA supporting publication 2014:EN-629
3
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively
by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender
procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be
considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the
issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
method (2 studies) or proton nuclear magnetic resonance spectroscopy (1 study). One study did not
report the analytical method for choline analysis. The weighted means (95% CIs) from all samples was
12.82 (12.21 – 13.44) mg/L for free choline and 105.71 (101.08 – 110.35) mg/L for total choline
concentrations, respectively. Weighted means (95% CIs) at different stages of lactation were as
follows (free choline/total choline): colostrum = 7.40 (0.59 – 14.21)/42.40 (23.58 – 61.22) mg/L;
mature milk = 9.69 (5.07 – 14.31)/159.59 (109.52 – 209.66) mg/L. When specified, milk samples were
collected from mothers who gave birth to term infants (weighted mean (95% CI) for free choline/total
choline: 8.97 (5.14 – 12.79)/56.90 (39.29 – 74.51) mg/L). Free choline breast milk concentrations
were (weighted means (95% CIs)): 11.63 (10.71 – 12.54) mg/L in women supplemented with choline
and 10.01 (8.97 – 11.05) mg/L in women non-supplemented. Total choline concentration was only
reported for non-supplemented women (weighted mean (95% CI)): 56.90 (39.29 – 74.51) mg/L. Two
studies investigated choline status (defined by free choline plasma concentration) and found a
correlation between choline status and breast milk free choline concentration. Breast milk
concentrations of choline, phosphatidylcholine and phosphocholine were significantly correlated with
total choline intake (mean 1088 mg/day) in one study.
Five studies reported phosphorus breast milk concentration. One study was free of confounders.
Phosphorus concentration was quantified via the ICP-MS analytical method (two studies). Three
studies did not report the analytical method for phosphorus. The weighted mean (95% CI) phosphorus
concentration from all samples was 132 (118 – 146) mg/L. Three studies were performed on mature
milk samples and 2 other studies did not give information on the stage of lactation. The involvement
of mothers of term or preterm infants was not specified. Phosphorus status (as defined by plasma
phosphorus concentration) was reported in 1 study. There was no information from these studies on
the relationship between phosphorus intake (including supplementation) or status and breast milk
concentration.
Three studies reported potassium breast milk concentration. No study was free of confounders.
Potassium concentration was quantified via the ICP-MS analytical method (3 studies). The weighted
mean (95% CI) potassium concentration from all samples was 561.10 (505.62 – 616.58) mg/L.
Mothers of preterm infants presented potassium breast milk concentration of (weighted mean (95%
CI)): 505.09 (411.82 – 598.35) mg/L; mothers of term infants presented potassium breast milk
concentration of (weighted mean (95% CI)): 449.63 (304.02 – 595.24) mg/L. None of the studies
reported intake and/or status data. There was no information from these studies on the relationship
between potassium intake (including supplementation) or status and breast milk concentration.
Vitamin A breast milk concentration was assessed in 19 publications (18 studies) via the quantification
of alpha-carotene (4 studies), beta-carotene (6 studies) or all-trans-retinol (8 studies). One study also
calculated total vitamin A concentration in retinol equivalents (RE), while 5 other studies reported
“vitamin A” concentration without specifying the compounds that were considered. Nine studies were
free of confounders. The analytical method employed was HPLC (17 studies). One study did not
record the analytical method. The weighted mean (95% CI) for retinol concentration from all samples
was 206.06 (195.14 – 216.97) µg/L. Weighted means (95% CIs) at different stages of lactation were
the followings: colostrum = 1 353.03 (271.72 – 2434.34) µg/L; transitional milk = 2 380.97 (2 125.18
– 2 636.75) µg/L; mature milk = 228.55 (216.15 – 240.94) µg/L. Weighted mean (95% CI) was
233.74 (221.36 – 246.12) µg/L for milk of mothers of term infants. The weighted mean (95% CI) was
333.13 (317.12 – 349.15) µg/L for milk from non-supplemented women. There was no data on breast
milk retinol concentration from supplemented women. Seven studies reported intake data; 6 studies
reported data on status as alpha-carotene, beta-carotene or retinol plasma concentration. One study
showed a positive correlation between the concentration of retinol in the milk and the intake of cod
liver, 1 study showed a positive correlation between maternal vitamin A intakes (as measured by total
“vitamin A + retinol” daily intakes) and milk retinol concentrations and between maternal plasma and
milk beta-carotene concentrations in non-smoker mothers, but not in smoker ones. Another study did
not find a correlation between breast milk vitamin A concentration (not specified) and intake of betaEFSA supporting publication 2014:EN-629
4
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively
by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender
procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be
considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the
issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
carotene. Two studies showed a positive correlation between maternal plasma retinol and milk retinol
concentrations.
Vitamin B1 breast milk concentration was assessed in 2 studies. One study was free of confounders.
The analytical method employed was either HPLC (1 study) or fluorimetry (1 study). The weighted
mean (95% CI) for vitamin B1 concentration from all samples was 44.7 (27.9 – 61.5) µg/L. Weighted
means (95% CIs) at different stages of lactation are as follows: transitional milk = 234.8 (24.6 –
494.1); mature milk = 68.6 (32.6 – 104.5). Milks were collected from mothers who gave birth to term
infants in one study, while in the other study the gestation stage was not specified. Weighted mean
(95% CI) was 71.7 (36.1 – 107.3) µg/L for milk of mothers of term infants. The weighted means (95%
CIs) were 67.1 (30.8 – 103.5) µg/L for milk from non-supplemented women vs. 185.3 (4.1 – 366.4)
µg/L for milk from supplemented women with vitamin B1. One study reported intake and status data
(vitamin B1 status assessed by erythrocyte transketolase activation assay). One study showed a
correlation between the concentration of vitamin B1 in mature milk and its intake.
Chloride breast milk concentration was assessed in 1 study. The analytical method employed was
spectrometric absorption. The weighted mean (95% CI) for chloride concentration from all samples
was 381.0 (328.4 – 433.7) mg/L. Milks were collected from mothers who gave birth to both term and
pre-term infants. Weighted means (95% CIs) were 373.8 (293.3 – 454.3) mg/L for breast milk of
mothers of preterm infants and 386.4 (317.0 – 455.9) mg/L for breast milk of mothers of term infants.
Copper breast milk concentration was assessed in 3 studies. None of the studies was free of
confounders. The analytical method employed was ICP-MS (2 studies) or FAAS (flame atomic
absorption spectrometry, 1 study). The weighted mean (95% CI) for copper concentration from all
samples was 264.05 (206.64 – 321.46) µg/L. Mature milks were collected from mothers who gave
birth to both term and preterm infants in one study, while in the 2 other studies the gestation stage was
not specified. None of the study reported maternal intake or status data allowing to assess the relation
between intake/status and breast milk concentration.
Magnesium breast milk concentration was assessed in 3 studies. None of the studies was free of
confounders. The analytical method employed was absorption spectrometry (1 study), ICP-AES (1
study) and ICP-MS (1 study). The weighted mean (95% CI) for magnesium concentration from all
samples was 34.83 (30.15 – 39.51) mg/L. Milks were collected from mothers who gave birth to both
term and pre-term infants. Weighted means (95% CIs) was 39.60 (32.67 – 46.54) mg/L for breast milk
of mothers of preterm infants and 31.60 (22.07 – 41.12) mg/L for breast milk of mothers of term
infants. None of the studies reported maternal intake or status data allowing to assess the relation
between intake/status and breast milk concentration.
Sodium breast milk concentration was assessed in 12 publications. None of the studies was free of
confounders. The analytical method employed was flame photometry (2 studies), absorption
spectrometry (1 study), gasometry (1 study), ICP-MS (1 study) and ion selective method (1 study). Six
studies did not report the analytical method used. The weighted mean (95% CI) for sodium
concentration from all samples was 371.1 (353.3 – 388.9) mg/L. Weighted means (95% CIs) at
different stages of lactation are as follows: colostrum = 538.2 (490.4 – 585.9) mg/L; transitional milk
= 1642.6 (1583.4 – 1701.8) mg/L (data on mature milk not reported). Milk samples were collected
from mothers who gave birth to both term and pre-term infants. Weighted means (95% CIs) were
183.6 (162.0 – 205.1) mg/L for breast milk of mothers of preterm infants and 850.4 (816.7 – 884.0)
mg/L for breast milk of mothers of term infants. None of the studies reported mothers’ intake or status
data allowing to assess the relation between intake/status and breast milk concentration.
EFSA supporting publication 2014:EN-629
5
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively
by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender
procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be
considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the
issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
TABLE OF CONTENTS
Abstract .................................................................................................................................................... 1
Summary .................................................................................................................................................. 2
Table of contents ...................................................................................................................................... 6
Background as provided by efsa .............................................................................................................. 7
Terms of reference as provided by efsa .................................................................................................... 7
Objectives ................................................................................................................................................. 8
Materials and Methods ............................................................................................................................. 8
1. Data collection ................................................................................................................................. 8
1.1.
Literature searches .................................................................................................................. 8
1.1.1. Search strategies ................................................................................................................. 8
1.1.2. Sources of publications ....................................................................................................... 9
1.1.3. Study selection.................................................................................................................... 9
1.1.4. Study management ........................................................................................................... 10
1.2.
Data extraction ...................................................................................................................... 11
1.2.1. Database ........................................................................................................................... 11
1.2.2. Quality assessment ........................................................................................................... 12
2. Data synthesis ................................................................................................................................ 13
2.1.
Data management: scaling .................................................................................................... 13
2.2.
Other processes ..................................................................................................................... 13
Results .................................................................................................................................................... 15
3. Literature searches and data collection .......................................................................................... 15
3.1.
Folates ................................................................................................................................... 15
3.2.
Zinc ....................................................................................................................................... 16
3.3.
Vitamin B6, Vitamin E, choline, phosphorus, potassium ..................................................... 16
3.4.
Vitamin A, Vitamin B1, chloride, sodium, copper and magnesium ..................................... 17
4. Description of results and analyses................................................................................................ 18
4.1.
Folates ................................................................................................................................... 18
4.2.
Zinc ....................................................................................................................................... 25
4.3.
Vitamin B6, Vitamin E, choline, phosphorus, potassium ..................................................... 38
4.3.1. Vitamin B6 ....................................................................................................................... 38
4.3.2. Vitamin E.......................................................................................................................... 46
4.3.3. Choline ............................................................................................................................. 63
4.3.4. Phosphorus ....................................................................................................................... 71
4.3.5. Potassium.......................................................................................................................... 73
4.4.
Vitamin A, Vitamin B1, chloride, copper, magnesium, sodium ........................................... 75
4.4.1. Vitamin A ......................................................................................................................... 75
4.4.2. Vitamin B1 ....................................................................................................................... 87
4.4.3. Chloride ............................................................................................................................ 89
4.4.4. Copper .............................................................................................................................. 91
4.4.5. Magnesium ....................................................................................................................... 92
4.4.6. Sodium.............................................................................................................................. 94
Conclusions ............................................................................................................................................ 99
References included ............................................................................................................................. 100
Appendices ........................................................................................................................................... 110
A. Search strategies for folates ......................................................................................................... 110
B. Search strategies for zinc ............................................................................................................. 116
C. Search strategies for Vitamin B6, Vitamin E, choline, phosphorus and potassium .................... 124
D. Search strategies for Vitamin A, Vitamin B1, chloride, copper, magnesium and sodium .......... 135
E. References for studies excluded on the basis of the country ....................................................... 145
F. References for studies excluded on the basis of the language ..................................................... 153
EFSA supporting publication 2014:EN-629
6
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively
by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender
procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be
considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the
issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
BACKGROUND AS PROVIDED BY EFSA
In 2005, the European Food Safety Authority (EFSA) received a mandate from the European
Commission to review the existing advice of the Scientific Committee for Food (SCF) published in
1993 (SCF 1993) on Dietary Reference Values (DRVs) for energy, macro- and micronutrients and
other substances with a nutritional or physiological effect. While the setting of DRVs for
macronutrients and energy has been finalised by the EFSA Panel on Dietetic Products, Nutrition and
Allergies (NDA), the work on micronutrients is ongoing.
A comprehensive literature search and review of compositional data of human breast milk is requested
in order to collect up-to-date information as preparatory work which will serve as a basis for the
assessment of the Working Group on DRVs for Vitamins and Minerals of the EFSA NDA Panel, in
relation to the establishment of DRVs for a selection of micronutrients.
In 2003, the Scientific Committee on Food (SCF) revised the essential requirements of infant formulae
and follow on formulae (SCF 2003), which included a review of compositional data of human milk
available at that time. In addition, more recent compositional data have already been collected for
some micronutrients in calls for tender CFT/EFSA/NUTRI/2011/01 (CFT/EFSA/NUTRI/2011/01
covered copper concentration of breast milk) and CFT/EFSA/NDA/03 (CFT/EFSA/NDA/03 covered
magnesium, potassium and fluoride concentrations of breast milk) in the context of EFSA’s work to
establish DRVs for micronutrients. The objective of the current project is to complement and update
data available from these sources.
TERMS OF REFERENCE AS PROVIDED BY EFSA
Comprehensive literature search and review of breast milk composition as preparatory work for the
setting of dietary reference values for vitamins and minerals. Call for tender
RC/EFSA/NUTRI/2013/06 – OC/EFSA/SAS/2012/01.
This contract was awarded by EFSA to:
Contractor: LASER Analytica Europe Limited, 66 Chiltern Street, London, W1U 4JT
Contract title: Comprehensive literature search and review of breast milk composition as preparatory
work for the setting of dietary reference values for vitamins and minerals
Contract number: RC/EFSA/NUTRI/2013/06 – OC/EFSA/SAS/2012/01
EFSA supporting publication 2014:EN-629
7
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively
by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender
procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be
considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the
issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
OBJECTIVES
The overall aim of this project was to collect data from the scientific literature on breast milk
concentrations for the following micronutrients:
-
Vitamins: vitamin A, vitamin E, choline, folate, vitamin B6, vitamin B1
-
Minerals: phosphorus, zinc, chloride, sodium, copper, potassium and magnesium
Information was collected following a systematic review process, involving literature searches and
data extraction in a database.
MATERIALS AND METHODS
1.
Data collection
1.1.
Literature searches
1.1.1.
Search strategies
Search strategies for the electronic databases consist of a logic combination (through Boolean
operators) of free text/specific database terms, based on search terms identified during preliminary
searches. Preliminary searches consisted in developing synonyms and other relevant keywords for the
nutrients of interest and on identifying keywords relative to breast milk composition.
Grey literature was searched by hand, by using some relevant keywords e.g., "breast/human milk
composition", "breast/human milk, vitamin", "breast/human milk, minerals" on search engines of
indicated websites/databases. Websites interface and structure were carefully screened for identifying
any relevant information.
The search strategy was conducted:
-
according to the search terms defined for each electronic database (see Section 1.1.2 and
appendices A-D);
-
with broad terms like “breast milk composition", "breast milk, vitamins", "breast milk,
minerals" for the grey literature searches;
-
in English language for the electronic databases; for the “grey literature” searches, English,
Polish and French searches were done;
-
when available, reviews were hand-searched for other relevant references, as was the
reference lists of included studies.
In order to meet EFSA’s requirements in terms of timeframe, searches for data on folates and zinc
were conducted separately while combined searches were carried out for data on vitamin B6, vitamin
E, choline, phosphorus and potassium, and for data on vitamin A, vitamin B1, chloride, sodium,
copper and magnesium, respectively.
The search strategies for the electronic databases and grey literature are detailed in full as appendices
A-D, together with the number of search results for each of the data sources.
EFSA supporting publication 2014:EN-629
8
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively
by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender
procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be
considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the
issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
1.1.2.
Sources of publications
In order to identify all pertinent citations, a focused search of the published literature was conducted
on the basis of the search strategies presented in the appendices. The following electronic databases
were searched:
-
PubMed
-
Web of Science
-
Embase
Additional searches under grey literature were also performed in parallel (national and international
health agencies, Google, Google scholar, Google books, Codex, Scientific Web plus, clinicaltrials.gov,
OAISTER, OpenGrey, other nursing databases, websites of organisations related to infant nutrition
and health e.g., World Health Organization, European Society for Paediatric Gastroenterology,
Hepatology and Nutrition or American Academy of Pediatrics and other relevant websites (see
appendices)) to obtain relevant data. Reports, such as reports from national and international health
agencies or reports from expert bodies, handbooks, and other non-peer reviewed studies were screened
according to inclusion and exclusion criteria. Sources from the EFSA Inventory of information sources
(http://www.metaxis.com/EFSAInventory/) have also been searched.
1.1.3.
Study selection
In compliance with the systematic review procedure recommended by EFSA2, study screening was
undertaken in two steps:
-
Initial screen – Screening of the titles and abstracts of all studies retrieved from the searches.
Studies included following this initial screening phase were processed for a more detailed
examination.
-
Detailed screen – Full text versions of the studies included following the initial screening
phase were then examined for inclusion in the review.
An initial screening of titles and abstracts against the inclusion and exclusion criteria presented in
Table 1 was conducted to identify potentially pertinent papers. All references sorted into the “include”
category were obtained for retrieval. For all references sorted as “uncertain” (when a definite decision
could not be made based on the title and/or abstract alone), the full paper was obtained for detailed
assessment against the inclusion criteria, thus enhancing the sensitivity of the initial selection step.
Two reviewers independently evaluated each potentially relevant reference (both on the basis of titles
and abstracts and full-texts). If there were any differences between the two reviewers in the decision to
include/exclude a study, a decision was taken by a third reviewer. Moreover, 10% of the excluded
studies were double-checked by a senior team member.
Information obtained from the grey literature in English, French and Polish languages was processed
for a detailed screening.
2
EFSA (European Food Safety Authority), 2010. Application of systematic review methodology to food and feed safety
assessments to support decision making. EFSA Journal 2010;8(6):1637, 90 pp. doi:10.2903/j.efsa.2010.1637 Available
online : http://www.efsa.europa.eu/fr/efsajournal/pub/1637.htm
EFSA supporting publication 2014:EN-629
9
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively
by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender
procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be
considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the
issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Table 1: Inclusion and exclusion criteria which applied for selecting studies according to the field
considered
Breast milk concentration
Review question
What is the concentration of folate, zinc, vitamin B6, vitamin E, choline,
phosphorus, potassium, vitamin A, vitamin B1, chloride, sodium, copper
and magnesium in breast milk?
Inclusion and exclusion criteria
Inclusion criteria:
Population of
interest
Healthy, well-nourished lactating women from Europe (geographical
Europe, excluding Russia), North America, Australia and New Zealand
Meta-analysis or systematic review
Inclusion criteria:
Study design
Intervention studies
Observational studies
Studies reporting on the composition of milk from milk banks
Inclusion criteria:
Outcome of interest
Concentration of folate, zinc, vitamin B6, vitamin E, choline, phosphorus,
potassium, vitamin A, vitamin B1, chloride, sodium, copper and magnesium
in breast milk samples
Articles published before January 2000 for folate, zinc, vitamin B6, vitamin
E, choline, phosphorus, vitamin A, vitamin B1, chloride and sodium
Articles published before October 2010 for potassium and magnesium
Articles published before January 2011 for copper
Exclusion criteria
Irrelevant population (considered not to be healthy, well-nourished or from
other countries)
Studies which do not report information on breast milk concentration for the
selected micronutrients
Duplicates: in the case where data are used in more than one study (1
original plus 1 or more secondary publications), the study providing the
most complete and detailed information was chosen
1.1.4.
Study management
The references were managed either directly with EndNoteTM software or with Reference Manager
before a conversion into EndNoteTM libraries. Separate libraries were created for included and
excluded studies, and based on the reason of exclusion. The main reasons of exclusion were defined
during the screening process (e.g., irrelevant population (e.g., unhealthy women), absence of outcome
of interest).
EFSA supporting publication 2014:EN-629
10
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively
by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender
procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be
considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the
issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Lists for studies excluded based on the country and potential relevant studies in other EU languages
are provided in Appendices E and F.
1.2.
Data extraction
1.2.1.
Database
The Excel database template, developed to include relevant study specifications (study design,
methods, population) and outcomes of interest as defined in the study protocol, served to collate
information extracted from both published scientific literature and grey literature. Each study was
described along with elements to support the critical appraisal of the strengths and limitations of the
recorded information. Data on breast milk concentration of the selected micronutrients and their
metabolites were extracted.
The concentrations and structure of the extraction grid was tailored to the requirements of EFSA.
Controlled terminology lists/picklists, based on the picklists used in the OECD templates, were used as
much as possible.
Data extraction was performed independently by two reviewers, with any discrepancies in extractions
to be corrected by a third reviewer.
Statistical descriptors of the primary endpoints and study design (e.g., sample size, geometric mean
and standard deviation, median, range, CIs, percentiles) were reported.
Micronutrient concentrations are expressed in µg/L or mg/L. When the reporting of nutrient
concentrations was done according to several units in the same publication, only values in µg/L or
mg/L were reported. If the study reports data in other units only, raw data were extracted in the
database before being converted.
Data extraction includes the following information, when available:
-
Reference:
o reference type;
o first author;
o year;
o title.
-
Study quality assessment:
o consideration of confounders (yes/no/unclear);
o description of confounders considered.
-
Study characteristics:
o type of study;
o number of subjects at start;
o number of subjects excluded (reason for exclusion)/lost at follow-up;
o final number of subjects per group (sample size);
o main statistical descriptor for age; value (years);
o statistical descriptor associated to age (variability); value (years);
o main statistical descriptor for weight; value (kg);
o statistical descriptor associated to weight (variability); value (kg);
o BMI;
o ethnicity (country of origin);
EFSA supporting publication 2014:EN-629
11
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively
by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender
procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be
considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the
issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
o country;
o smoking status;
o supplementation (vitamins, minerals);
o details on supplementation;
o micronutrient intake (intake from dietary sources, oral supplements and/or fortified
foods);
o data on the methods used to collect intake data;
o micronutrient status (whole-blood/serum or plasma/erythrocyte concentrations of the
micronutrient of interest; urinary excretion of the micronutrients; other relevant
biomarkers of status for the micronutrient of interest);
o main statistical descriptor for micronutrient status; value; unit;
o statistical descriptor associated to micronutrient status (variability); value; unit.
o data on the methods used to estimate status;
o vegan/vegetarian diet;
o other individual specificities (alcohol consumption, delivery by vaginal route or
caesarean section, primiparous/multiparous);
o mothers of term/preterm infants;
o stage of lactation (defined as follows: colostrum: 1-4 days post-partum; transitional
milk: 5-15 days postpartum; mature milk: > 15 days postpartum);
o number of days/months post-partum;
o breast feeding;
o type of milk sample;
o type of extraction;
o method for data collection (year/period/time of the day);
o analytical method applied;
o validation status for the analytical method (appropriate quality controls?);
o Limit of detection (LOD)/Limit of Quantification (LOQ) of analytical method
applied.
-
Micronutrient concentrations:
o number of samples analysed
o micronutrient of interest
o micronutrient (parent compound, specific isomer, metabolite, as recorded in the
publication)
o type of reporting
o main statistical descriptor for concentration; value; unit;
o statistical descriptor associated (uncertainty, variability); value; unit.
o other statistical descriptor for concentration; value; unit;
o statistical descriptor associated (uncertainty, variability); value; unit;
-
Relationship between intake/status and milk concentration of micronutrient of interest
When information was not available from the paper, “not reported” or “not recorded” or “-” was
recorded in the corresponding field.
The Excel extraction datasheet is provided to EFSA together with this report.
1.2.2.
Quality assessment
Besides the provision of study summary and major findings for each included study, a qualitative
critical appraisal was performed for both peer-reviewed articles and grey literature.
EFSA supporting publication 2014:EN-629
12
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively
by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender
procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be
considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the
issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Attention was paid to potential confounding factors associated with the characteristics of the study
population (details on supplementation or not, health status) and milk samples (stage of lactation, i.e.,
colostrum, transitional milk, mature milk). Consideration of potential confounders was recorded in the
Excel database as free text. However, as the confounding factors were mainly explained by the lack of
information (e.g., when there was no detail on supplementation, breast milks samples may come from
women supplemented, not supplemented, or from both women supplemented and those not
supplemented), both studies free of confounders and those presenting confounders were used in the
analyses, except if explicitly stated (when there were strong doubts according to study quality).
Reliability/usefulness of analytical methods applied was also assessed for each study individually
according to the presence of quality controls (standard reference materials) and sufficient details on
the validation of the analytical method applied (i.e., recovery, repeatability, limit of detection (LOD),
limit of quantification (LOQ)). For all studies, there was sufficient information on the method used to
consider it as reliable. However, for some studies, there were strong doubts according to the units
recorded. Results coming from these studies were reported in the database but not used in the analyses.
2.
2.1.
Data synthesis
Data management: scaling
When the values for micronutrient concentrations were expressed in other units than µg/L or mg/L, a
conversion was made in an additional column of the excel sheet.
When the values were expressed in molar concentration, the molecular masses used were: 35.45 g/mol
for chloride; 104.17 g/mol for choline (free and total); 441.39 g/mol for folate, 445.43 g/mol for
tetrahydrofolate, 459.46 g/mol for 5-methyltetrahydrofolate; 24.30 g/mol for magnesium; 31 g/mol for
phosphorus; 39.10 g/mol for potassium; 22.99 g/mol for sodium; 286.45 g/mol for retinol, 538.87
g/mol for alpha and beta-carotene; 265.3546 g/mol for vitamin B1; 430.70 g/mol for alpha-tocopherol,
402.65 g/mol for delta-tocopherol, 416.68 g/mol for gamma-tocopherol; 169.18 g/mol for vitamin B6,
167.16 for pyridoxal, 168.19 g/mol for pyridoxamine, 169.18 g/mol for pyridoxine; 65.39 g/mol for
zinc.
2.2.
Other processes
A weighted mean analysis on micronutrient concentrations in milk was performed on all the data for
the identified sub-groups:
1) all samples (i.e., samples from mothers of term or pre-term infants, supplemented or not, all
stages of lactation).
2) mothers of pre-term infants (when explicitly stated);
3) mothers of term infants (when explicitly stated);
4) colostrum milk samples (1-4 days post-partum), from women of term infants (when no
information was available on the length of gestation (term vs. preterm), values were
excluded from the calculations);
5) transitional milk samples (5-15 days postpartum), from women of term infants;
EFSA supporting publication 2014:EN-629
13
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively
by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender
procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be
considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the
issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
6) mature milk samples (> 15 days postpartum), from women of term infants;
7) milks from mothers supplemented with the micronutrient of interest (when explicitly stated
than more than ¾ of the women took supplements containing the micronutrient of interest);
8) milks from mothers non-supplemented with the micronutrient of interest (when explicitly
stated)
Weighted means
were weighted according to the inverse variance:
(1)
where
are the individual inverse variances and
the individual means or medians3.
Standard error for each weighted mean was computed as below:
(2)
The lower limit of the 95% CI LCI was calculated as:
(3)
The upper limit of the 95% CI UCI was calculated as:
(4)
3
Hozo, S. P., Djulbegovic, B. et al. (2005). “Estimating the mean and variance from the median, range, and the size of a
sample.” BMC Medical Research Methodology 5(13).
EFSA supporting publication 2014:EN-629
14
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively
by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender
procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be
considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the
issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
RESULTS
3.
3.1.
Literature searches and data collection
Folates
The merging of records retrieved from the three databases provided a total of 968 abstracts, after
elimination of duplicates. Screening of the reference lists of the included articles allowed the retrieval
of one study. Searches on the grey literature, as detailed in Appendix A, did not recover relevant
sources of information.
The following Figure 1 presents the flowchart for the studies dealing with folate which have been
identified, extracted and selected.
Figure 1: Flowchart for studies on folates
EFSA supporting publication 2014:EN-629
15
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively
by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender
procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be
considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the
issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
3.2.
Zinc
The merging of records retrieved from the three databases provided a total of 973 abstracts, after
elimination of duplicates. No additional articles were retrieved from the screening of the reference lists
of the included articles. Searches on the grey literature, as detailed in Appendix B, did not recover
relevant sources of information.
The following Figure 2 presents the flowchart for the studies dealing with zinc which have been
identified, extracted and selected.
Figure 2: Flowchart for studies on zinc
3.3.
Vitamin B6, Vitamin E, choline, phosphorus, potassium
The merging of records retrieved from the three databases provided a total of 1081 abstracts, after
elimination of duplicates. No additional articles were retrieved from the screening of the reference lists
of the included articles. Searches on the grey literature, as detailed in Appendix C, did not recover
relevant sources of information.
The following Figure 3 presents the flowchart for the studies dealing with vitamin B6, vitamin E,
choline, phosphorus and potassium which have been identified, extracted and selected.
EFSA supporting publication 2014:EN-629
16
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively
by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender
procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be
considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the
issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Figure 3: Flowchart for studies on vitamin B6, vitamin E, choline, phosphorus and potassium
3.4.
Vitamin A, Vitamin B1, chloride, sodium, copper and magnesium
The merging of records retrieved from the three databases provided a total of 3 227 abstracts, after
elimination of duplicates. No additional articles were retrieved from the screening of the reference lists
of the included articles. Searches on the grey literature, as detailed in Appendix D, did not recover
relevant sources of information.
The following Figure 4 presents the flowchart for the studies dealing with vitamin A, vitamin B1,
chloride, copper, magnesium and sodium which have been identified, extracted and selected.
EFSA supporting publication 2014:EN-629
17
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively
by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender
procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be
considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the
issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Figure 4: Flowchart for studies on vitamin A, vitamin B1, chloride, copper, magnesium and sodium
A full list of included and excluded studies, further grouped according to the rationale for their
exclusion, are provided under the form of EndNoteTM libraries. Full-texts of the included studies are
also shared with EFSA.
4.
4.1.
Description of results and analyses
Folates
As described in the study flow diagram, 8 publications were included from the comprehensive
literature search on folate breast milk concentration (January 2000 – January 2014). Details on which
are in the following Table 2.
EFSA supporting publication 2014:EN-629
18
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively
by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender
procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be
considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the
issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Table 2:
Publication
(SanchezHidalgo, FloresHuerta
et
al.
2000)
Summary of the included studies for folate
Population main
characteristics
Supplementation?
Maternal folate
intake
Stage of
lactation
Confounding
factors?
Analytical
method
“Folate”
concentration in
breast milk (a)
Number of women
(number of samples)
Not reported
Not reported
Not reported
Not reported
Yes:
no
information
on
type of milk nor
on women details;
besides, there is a
strong suspicion
of a mistake in the
article for the
recording of the
value
(this
measure has been
excluded from the
calculations)
Not reported
Total folate:
Mean: 0.05 µg/L
Not reported (Not
reported)
Total folate:
Mean ± SD: 47.8
± 31.9 µg/L
68 (68)
(Villalpando,
Latulippe et al.
2003)
Hispanic
population from a
specific
community of
Mexico; mothers
of term infants
Not reported
Median (1st, 3rd
quartile): 86 (38,
137) µg
Mature milk (22
± 13 days
postpartum)
Yes: targeted
population and
“nutritional
anemia” (as
reported in the
publication) for
62% of women
(Kim, Yang et al.
2004)
Canadian women
mothers of term
infants
Yes: 9 of the 12
lactating mothers
consumed vitamin
supplements;
all
containing
4001000 µg of folic
acid
Not reported
Mature milk (1-6
months
postpartum)
Yes:
few
information
on
population
and
lack
of
information
on
specific
folate
supplementation
Microbiological
assay
Microbiological
assay
Total folate: All
women (9
supplemented, 3
not
supplemented):
Mean ± SD: 51.6
± 20.3 µg/L
12 (12)
Median (1st-3rd
quartiles): 53.4
EFSA supporting publication 2014:EN-629
19
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Publication
Population main
characteristics
Supplementation?
Maternal folate
intake
Stage of
lactation
Confounding
factors?
Analytical
method
“Folate”
concentration in
breast milk (a)
Number of women
(number of samples)
µg/L (35.4 – 59.9)
(Khambalia,
Latulippe et al.
2006)
(Houghton, Yang
et al. 2009)
Hispanic
population from a
specific
community
of
Mexico; mothers
of term infants
(same population
than
the
one
investigated in the
Villalpando 2003
study;
here
subgroups
of
population
are
investigated)
Canadian women
No
Median (1st, 3rd
quartile): 86 (38,
137) µg
Mature milk (22 ±
13
days
postpartum)
Yes: multivitamin
supplements
comprising
folic
acid 400 µg and Fe
18 mg (length of
supplementation
before sampling not
reported)
Mature milk (82 ±
15
days
postpartum)
Yes: multivitamin
supplements
comprising
folic
acid 400 µg without
Fe and with other
vitamins (length of
supplementation
before sampling not
reported)
Mature milk (138
±
18
days
postpartum)
Yes:
[6S]-5methylTHF
(416
µg/d)
EFSA supporting publication 2014:EN-629
Yes:
targeted
population
and
“nutritional
anemia”
(as
reported in the
publication) for
62% of women
Total folate:
Median (1st-3rd
quartiles): 45.2
µg/L (39.5 – 57.0)
Microbiological
assay
Daily average dose
(mean ± SD): 416
µg
5-Me-THF
during lactation +
911 ± 251 µg folic
acid
during
pregnancy
Mature milk (4
weeks
postpartum)
Total folate:
Median (1st-3rd
quartiles): 68.4
µg/L (56.8 – 78.7)
68 (68)
Total folate:
Median (1st-3rd
quartiles): 63.6
µg/L (53.9 – 79.1)
No
Liquid
chromatography
Total folate:
Mean ± SD: 83.4
± 23.0 µg/L
55 (55) (no detail on
number by subgroup)
20
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Publication
Population main
characteristics
Supplementation?
Maternal folate
intake
Stage of
lactation
Confounding
factors?
Analytical
method
“Folate”
concentration in
breast milk (a)
No during lactation
Daily average dose
(mean ± SD): 911 ±
251 µg folic acid
during pregnancy
Total folate:
Mean ± SD: 77.2
± 19.0 µg/L
Yes: Folic acid, 400
µg/d
Daily average dose
(mean ± SD): 400
µg during lactation
+ 911 ± 251 µg
folic acid during
pregnancy
Total folate:
Mean ± SD: 80.3
± 45.0 µg/L
Yes:
[6S]-5methylTHF
(416
µg/d)
Daily average dose
(mean ± SD): 416
µg
5-Me-THF
during lactation +
911 ± 251 µg folic
acid
during
pregnancy
No during lactation
Daily average dose
(mean ± SD): 911 ±
251 µg folic acid
during pregnancy
Total folate:
Mean ± SD: 91.4
± 33.5 µg/L
Yes: Folic acid, 400
µg/d
Daily average dose
(mean ± SD): 400
µg during lactation
+ 911 ± 251 µg
folic acid during
pregnancy
Total folate:
Mean ± SD: 80.8
± 25.2 µg/L
Yes:
[6S]-5methylTHF
(416
Daily average dose
(mean ± SD): 416
EFSA supporting publication 2014:EN-629
Mature milk (8
weeks
postpartum)
Mature milk (16
weeks
Number of women
(number of samples)
Total folate:
Mean ± SD: 85.2
± 27.4 µg/L
Total folate:
Mean ± SD: 68.4
53 (53) (no detail on
number by subgroup)
21 (21)
21
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Publication
Population main
characteristics
Stage of
lactation
µg/d)
µg
5-Me-THF
during lactation +
911 ± 251 µg folic
acid
during
pregnancy
postpartum)
No during lactation
Daily average dose
(mean ± SD): 911 ±
251 µg folic acid
during pregnancy
Total folate:
Mean ± SD: 77.7
± 35.3 µg/L
20 (20)
Daily average dose
(mean ± SD): 400
µg during lactation
+ 911 ± 251 µg
folic acid during
pregnancy
Total folate:
Mean ± SD: 70.2
± 34.9 µg/L
16 (16)
Folic acid: Mean
± SD: 18.4 ± 0.6
µg/L
Not reported (5)
Yes: Folic acid, 400
µg/d
(Alvarez-Sanchez,
Priego-Capote et
al. 2010)
Not reported
(West, Yan et al.
2012) and (Yan,
Jiang et al. 2012)
for description
American women
Not reported
Yes: 750 µg/d of
folic acid
EFSA supporting publication 2014:EN-629
Not reported
Daily average dose
from both food and
supplementation
(mean): 1150 µg
Not reported
Mature milk (5
weeks
postpartum)
Confounding
factors?
Analytical
method
“Folate”
concentration in
breast milk (a)
Maternal folate
intake
Supplementation?
Number of women
(number of samples)
± 24.3 µg/L
Yes:
no
information
on
type of milk nor
on
women
characteristics
Liquid
chromatography
No
Liquid
chromatography
Total folate:
Mean (95% CI):
56.2 (48.8 – 64.2)
µg/L
28 (28)
5-CH3-H4-folate:
Mean (95% CI):
14 (10.8 – 17.6)
µg/L
22
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Publication
Population main
characteristics
Supplementation?
Maternal folate
intake
Stage of
lactation
Confounding
factors?
Analytical
method
“Folate”
concentration in
breast milk (a)
Number of women
(number of samples)
Folic acid: Mean
(95% CI): 16.2
(11.8 – 21.3) µg/L
Mature milk (15
weeks
postpartum)
Total folate:
Mean (95% CI):
61.8 (54.1 – 70.0)
µg/L
5-CH3-H4-folate:
Mean (95% CI):
16.3 (12.8 – 20.2)
µg/L
Folic acid: Mean
(95% CI): 24.1
(18.7 – 30.3) µg/L
(Buttner, Witthoft
et al. 2013)
Not
reported,
samples coming
from
Swedish
milk banks
Not
reported,
samples
coming
from Swedish milk
banks
Not reported
Mature milk (until
3
months
postpartum)
Yes:
information
population
no
on
Total folate:
Mean ± SD: 66.2
± 20.3 µg/L
Liquid
chromatography
H4-folate: Mean
± SD: 14.70 ±
6.68 µg/L
n.a. (38)
5-CH3-H4-folate:
Mean ± SD: 53.76
± 17.00 µg/L
EFSA supporting publication 2014:EN-629
23
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Publication
Population main
characteristics
Supplementation?
Maternal folate
intake
Stage of
lactation
Confounding
factors?
Analytical
method
“Folate”
concentration in
breast milk (a)
Number of women
(number of samples)
Weighted mean analysis for total folate concentration in women mature milk:
Women supplemented with folic acid or [6S]-5-methylTHF (weighted mean ± SE (95% CI)): 60.4 ± 2.8 µg/L (54.8 – 65.9) (4 studies)
Women not supplemented (weighted mean ± SE (95% CI)): 48.7 ± 4.7 µg/L (39.6 – 57.8) (3 studies)
Women mothers of term infants, mature milk (weighted mean ± SE (95% CI)): 52.7 ± 3.9 µg/L (45.0 – 60.3) (3 studies)
All samples (weighted mean ± SE (95% CI)): 57.3 ± 2.4 µg/L (52.6 – 62.0) (6 studies)
(a)
Total folate concentrations are reported. Folic acid, 5-CH3-H4 folate, H4 folate concentrations are also reported, when available.
The comprehensive literature searches on folate concentration in human breast milk retrieved 8 relevant studies. Two studies were free of confounders (Houghton,
Yang et al. 2009; West, Yan et al. 2012). When reported, the analytical method used for folate measurements is mainly high performance liquid chromatography–
mass spectrometry (HPLC-MS/MS, 4 studies). Microbiological assays are also reported (3 studies). One study did not report the analytical method for folate. Forms
of folate analysed are total folate (7 studies), folic acid (2 studies), 5-CH3-H4 folate (2 studies), H4 folate (1 study), and the catabolites p-aminobenzoylglutamate
and acetamide-p-aminobenzoylglutamate (1 study). In 4 of the studies, mothers were taking folate supplement (folic acid ranging 400-1000 µg/d or [6S]-5methylTHF 416 µg/d) (Kim, Yang et al. 2004; Khambalia, Latulippe et al. 2006; Houghton, Yang et al. 2009; West, Yan et al. 2012).
The weighted mean and 95% CI folate concentration from all samples was 57.3 (52.6 – 62.0) µg/L. Three studies involved mothers of term infants, all of those
were performed on mature milk samples (weighted mean and 95% confidence interval (CI): 52.7 (45.0 – 60.3) µg/L).
Relationship between intake/status and breast milk concentration of folate was assessed in 3 studies (Khambalia, Latulippe et al. 2006; Houghton, Yang et al. 2009;
West, Yan et al. 2012). Two studies found no association between folic acid supplementation and total folate concentration in breast milk (Khambalia, Latulippe et
al. 2006; Houghton, Yang et al. 2009). The third one (West, Yan et al. 2012) found a relationship between folic acid concentration in breast milk and intake of
folates (i.e., natural folate + folic acid supplementation), but not between total folate concentration in breast milk and folate intake. Women supplemented with folic
acid presented breast milk concentrations of total folate of (weighted mean and 95% CI) 60.4 (54.8 – 65.9) µg/L; those not supplemented presented breast milk
concentrations of total folate of (weighted mean and 95% CI) 48.7 (39.6 – 57.8) µg/L.
EFSA supporting publication 2014:EN-629
24
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
4.2.
Zinc
As described in the study flow diagram, 41 studies were included from the comprehensive literature search on zinc breast milk concentration (January 2000 – January
2014). Details on which are in the following Table 3.
Table 3:
Summary of the included studies for zinc
Publication
Population main
characteristics
(Silvestre, Lagarda
et al. 2000)
Study performed in
Spain
(Silvestre, Lagarda
et al. 2000)
Study performed in
Spain
Supplementation
with the nutrient
of interest?
Not reported
No
Maternal zinc
intake
Not reported
Not reported
Stage of lactation
Colostrum
Study performed in
Spain
Not reported
EFSA supporting publication 2014:EN-629
Not reported
Yes: no information
on supplementation
Analytical
method
FAAS(a)
microwave
digestion
with
Zinc
concentration in
breast milk
Mean ± SD: 8.60 ±
1.82 mg/L
Transitional milk
Mean ± SD: 3.45 ±
0.58 mg/L
Mature milk (30
days postpartum)
Mean ± SD: 1.97 ±
0.25 mg/L
Mature milk (60
days postpartum)
Mean ± SD: 1.24 ±
0.33 mg/L
Mature milk (90
days postpartum)
Mean ± SD: 0.89 ±
0.27 mg/L
Colostrum (3 days
postpartum)
Transitional
(15
postpartum)
(Rodriguez
Rodriguez,
Sanz
Alaejos et al. 2000)
Confounding
factors?
No
FAAS
microwave
digestion
milk
days
Mature milk (2
weeks – 5 months
postpartum)
Yes: no information
on supplementation
AAS(a)
with
Number of
women (number
of samples)
Not reported (10)
Mean ± SD: 7.73 ±
0.86 mg/L
39 (unclear)
Mean ± SD: 3.15 ±
0.86 mg/L
15 (unclear)
Mean
±
SD
(range): 2.10 ±
1.10 (0.14 – 3.99)
11 (56)
25
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Publication
Population main
characteristics
Supplementation
with the nutrient
of interest?
Maternal zinc
intake
Stage of lactation
Confounding
factors?
Analytical
method
Zinc
concentration in
breast milk
Number of
women (number
of samples)
mg/L
(Sanchez-Hidalgo,
Flores-Huerta et al.
2000)
Study performed in
Mexico
Not reported
Not reported
Milk for preterm
newborn
Yes: no information
on type of milk nor
on women details
Not reported
Individual
1.20 mg/L
(Bocca, Alimonti et
al. 2000)
Study performed in
Italy
Not reported
Not reported
Not reported
Yes: no information
on supplementation
liquid
chromatography
with ICP-AES
Mean
±
SD
(median/range):
2.72
±
0.07
(0.65/0.28-2.42)
mg/L
Not reported (60)
(Bosscher,
Van
Caillie-Bertrand et
al. 2001)
Not reported
Not reported
Not reported
Mature milk
Yes: no information
on supplementation
FAAS
Mean ± SD: 1.00 ±
0.1 mg/L
4 (4)
(Gulson, Mizon et
al. 2001)
Study conducted in
Australia on 6
Australians and 31
migrants
(17
subjects remained
included in the
study)
Not reported
5,33 mg/day for
migrants,
6,76
mg/day
for
australians
Not reported
Yes: no information
on supplementation
Not reported
Mean
±
SD
(Median): 2.08 ±
0.91 (1.89) mg/L
17 (78)
(Hendricks, Guo et
al. 2001)
Not reported
Not reported
Not reported
Mature milk
months
postpartum)
(4
Yes: no information
on supplementation
AES
Mean ± SD: 1.20 ±
0.01 mg/L
7 (7)
(Kantola
and
Vartiainen 2001)
Study performed in
Finland
with
samples collected
in 1987
Not reported
Not reported
Mature milk (4
weeks postpartum)
Yes: no information
on supplementation
FAAS
Mean ± SD: 3.00 ±
1.00 mg/L
175 (175)
EFSA supporting publication 2014:EN-629
data:
Not reported (Not
reported)
26
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Publication
Population main
characteristics
Supplementation
with the nutrient
of interest?
Maternal zinc
intake
Stage of lactation
Confounding
factors?
Analytical
method
Study performed in
Finland
with
samples collected
in 1993-95
Zinc
concentration in
breast milk
Number of
women (number
of samples)
Mean ± SD: 1.40 ±
0.70 mg/L
81 (81)
(Turan, Saygi et al.
2001)
Study performed in
Turkey
No
Not reported
Colostrum
(48
hours post-partum)
No
FAAS
Mean
±
SD
(range): 12.9 ±
7.30
(4.5-27.1)
mg/L
30 (30)
(Silvestre,
Martinez-Costa et
al. 2001)
Study performed in
Spain, mothers of
term infants
Not reported
Not reported
Colostrum (day 2
and 4 postpartum)
Yes: no information
on supplementation
FAAS
Mean ± SD: 7.99 ±
3.23 mg/L
22 (110)
(Wasowicz,
Gromadzinska
al. 2001)
et
Study performed in
Poland, mothers of
term infants
Not reported
Not reported
Transitional milk
(during the 2nd
week)
Mean ± SD: 3.31 ±
1.06 mg/L
Mature milk (30
days postpartum)
Mean ± SD: 2.41 ±
0.90 mg/L
Mature milk (60
days postpartum)
Mean ± SD: 1.40 ±
0.65 mg/L
Mature milk (90
days postpartum)
Mean ± SD: 1.05 ±
0.71 mg/L
Colostrum
(0-4
days postpartum)
Transitional
(5-9
postpartum)
EFSA supporting publication 2014:EN-629
milk
days
Yes: no information
on supplementation
ICP-AES
Mean ± SD: 8.2 ±
2.8 mg/L
43 (not recorded)
Mean ± SD: 3.7 ±
1.8 mg/L
46 (not recorded)
27
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Publication
Population main
characteristics
Supplementation
with the nutrient
of interest?
Maternal zinc
intake
Stage of lactation
Confounding
factors?
Analytical
method
Mature milk (10-30
days postpartum)
Zinc
concentration in
breast milk
Number of
women (number
of samples)
Mean ± SD: 1.4 ±
0.7 mg/L
41 (not recorded)
(Guillot, Roth et al.
2003)
Caucasian (France)
mother of preterm
infant
Not reported
Not reported
Mixed ColostrumTransitionalmature milk (< 45
days postpartum)
Yes:
low
representativity of
the results (1 case)
Not reported
Individual
0.35 mg/L
data:
1 (1)
(Bosscher, Van et
al. 2003)
Not reported
Not reported
Not reported
Mature milk
Yes: no information
on supplementation
FAAS
Mean ± SD: 3.00 ±
0.3 mg/L
4 (4)
(Domellof, Hernell
et
al.
2004;
Domellof,
Lonnerdal et al.
2004)
Data on women in
Sweden
Not reported
Not reported
Mature milk (6-9
months
postpartum)
Yes: no information
on supplementation
AAS
Mean ± SD: 0.46 ±
0.86 mg/L
86
(Etcheverry,
Wallingford et al.
2004)
Mothers of term
infants
Not reported
Not reported
Not reported
Yes: no information
on supplementation
ICP-ES
Individual
0.30 mg/L
Not reported (5)
(Sievers
and
Schaub 2004)
Study performed in
Germany: woman
1 followed for her
1st baby
Not reported
Not reported
Mature milk (5
weeks postpartum)
Yes:
low
representativity of
the results (case
study with only 1
woman per group)
AAS
Median
(range):
2.70 (1.00 – 4.40)
mg/L
1 (54)
Median
(range):
2.90 (0.80 – 5.90)
mg/L
1 (47)
Median
(range):
1.80 (0.80 – 2.50)
mg/L
1 (24)
Mature milk (8
weeks postpartum)
Mature milk (12
weeks postpartum)
EFSA supporting publication 2014:EN-629
As several
samples
analysed,
results
included
in
weighted
milk
were
these
were
the
mean
data:
28
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Publication
Population main
characteristics
Supplementation
with the nutrient
of interest?
Maternal zinc
intake
Stage of lactation
Mature milk (16
weeks postpartum)
Study performed in
Germany: woman
1 followed for her
2nd baby
Study performed in
Germany: woman
2 followed for her
n baby
EFSA supporting publication 2014:EN-629
Confounding
factors?
analyses.
Analytical
method
Zinc
concentration in
breast milk
Number of
women (number
of samples)
Median
(range):
1.60 (0.60 – 4.00)
mg/L
1 (29)
Mature milk (5
weeks postpartum)
Median
(range):
2.50 (2.00 – 3.70)
mg/L
1 (12)
Mature milk (8
weeks postpartum)
Median
(range):
2.20 (1.40 – 3.10)
mg/L
1 (19)
Mature milk (12
weeks postpartum)
Median
(range):
1.70 (0.30 – 2.10)
mg/L
1 (13)
Mature milk (16
weeks postpartum)
Median
(range):
1.70 (1.20 – 2.40)
mg/L
1 (20)
Mature milk (5
weeks postpartum)
Median
(range):
3.60 (2.90 – 4.20)
mg/L
1 (47)
Mature milk (8
weeks postpartum)
Median
(range):
2.50 (1.20 – 3.30)
mg/L
1 (52)
Mature milk (12
weeks postpartum)
Median
(range):
2.30 (1.40 – 3.30)
mg/L
1 (43)
29
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Publication
Population main
characteristics
Supplementation
with the nutrient
of interest?
Maternal zinc
intake
Study performed in
Germany: woman
2 multiparous for
her n+1 baby
Stage of lactation
Confounding
factors?
Analytical
method
Zinc
concentration in
breast milk
Number of
women (number
of samples)
Mature milk (16
weeks postpartum)
Median
(range):
1.90 (1.00 – 3.40)
mg/L
1 (54)
Mature milk (5
weeks postpartum)
Median
(range):
2.90 (1.80 – 4.30)
mg/L
1 (14)
Mature milk (8
weeks postpartum)
Median
(range):
2.90 (1.50 – 3.90)
mg/L
1 (44)
Mature milk (12
weeks postpartum)
Median
(range):
1.50 (0.60 – 2.90)
mg/L
1 (43)
Mature milk (16
weeks postpartum)
Median
(range):
2.00 (1.00 – 3.40)
mg/L
1 (42)
(Elmastas, Can et
al. 2005)
Study performed in
Turkey
Not reported
Not reported
Mature milk
No
FAAS
Mean ± SD: 1.20 ±
0.01 mg/L
32 (32)
(Spevackova,
Rychlik
et
2005)
Study conducted in
Czech Republic
Not reported
Not reported
Not reported
Yes: no information
on supplementation
FAAS
Mean ± SD: 41.7 ±
2.1 µg/g (not taken
into account in the
weighted
mean
analysis
because
unit
conversion
was undoable)
207 (not reported)
al.
(Ustundag, Yilmaz
Study performed in
Not reported
Not reported
Colostrum
Yes: no information
FAAS
Mean ± SD: 3.08 ±
20 (20)
EFSA supporting publication 2014:EN-629
(0-7
30
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Publication
et al. 2005)
Population main
characteristics
Supplementation
with the nutrient
of interest?
Maternal zinc
intake
Turkey, mothers of
term infants
Stage of lactation
days postpartum)
Transitional
(7-14
postpartum)
Study performed in
Turkey, mothers of
preterm infants
(Leotsinidis,
Alexopoulos et al.
2005)
Greek women
No
Not reported
Analytical
method
on supplementation
Zinc
concentration in
breast milk
Mean ± SD: 2.72 ±
0.20 mg/L
Mature milk (21
days postpartum)
Mean ± SD: 2.65 ±
0.20 mg/L
Mature milk (60
days postpartum)
Mean ± SD: 2.81 ±
0.18 mg/L
Colostrum
(0-7
days postpartum)
Mean ± SD: 2.41 ±
0.28 mg/L
Transitional
(7-14
postpartum)
milk
days
Mean ± SD: 2.28 ±
0.19 mg/L
Mature milk (21
days postpartum)
Mean ± SD: 2.39 ±
0.20 mg/L
Mature milk (60
days postpartum)
Mean ± SD: 2.01 ±
0.18 mg/L
Colostrum (3 days
postpartum)
milk
days
No
Number of
women (number
of samples)
0.30 mg/L
milk
days
Transitional
(17
EFSA supporting publication 2014:EN-629
Confounding
factors?
FAAS
Mean
±
SD
(median/range):
4.91
±
1.73
(5.01/1.32-9.12)
mg/L
180 (180)
95 (95)
Mean
±
SD
(median/range):
31
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Publication
Population main
characteristics
Supplementation
with the nutrient
of interest?
Maternal zinc
intake
Stage of lactation
Confounding
factors?
Analytical
method
postpartum)
Zinc
concentration in
breast milk
Number of
women (number
of samples)
2.99
±
0.92
(2.97/0.86-6.55)
mg/L
(Leverkus, Kutt et
al. 2006)
Mothers of preterm
infants
Not reported
Not reported
Mature milk
Yes:
low
representativity of
the result (1 case)
Not reported
Individual
0.14 mg/L
(Piotrowska-Dept,
PiotrowskaJastrzebska et al.
2006)
Study performed in
Poland,
white
women
Not reported
Zinc:
average
intake of natural
food 10.7 ± 3.3
mg/d (range: 5.718.2 mg/d)
Mixed (< 30 days
postpartum)
Yes: no information
on supplementation
AAS
Mean
±
SD
(range): 3.42 ±
1.62 (0.53 – 7.28)
mg/L
27 (27)
Mature milk (31-90
days postpartum)
Mean
±
SD
(range): 1.50 ±
0.87 (0.12 – 3.58)
mg/L
18 (18)
Mature milk (90
days postpartum)
Mean
±
SD
(range): 0.86 ±
0.57 (0.28 – 1.51)
mg/L
8 (8)
Individual
0.26 mg/L
data:
1 (1)
Individual
0.23 mg/L
data:
1 (1)
Individual
1.20 mg/L
data:
1 (1)
(Chowanadisai,
Lonnerdal et al.
2006)
(Coelho, Fernandes
et al. 2006)
Study performed in
USA
Mother of preterm
infant
Not reported
Not reported
EFSA supporting publication 2014:EN-629
Not reported
Not reported
Mature milk
Not reported
Yes: low reliability
of the results (1
case)
Yes:
low
representativity of
the result (1 case)
Not reported
Not reported
data:
1 (1)
32
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Publication
Population main
characteristics
(Kienast, Roth et
al. 2007)
Mother of preterm
infant
Supplementation
with the nutrient
of interest?
Not reported
Maternal zinc
intake
Not reported
Stage of lactation
Confounding
factors?
Mature milk (20
weeks postpartum)
Yes:
low
representativity of
the result (1 case)
Analytical
method
Not reported
Zinc
concentration in
breast milk
Number of
women (number
of samples)
Individual
0.27 mg/L
value:
1 (1)
Individual
0.33 mg/L
value:
1 (1)
Individual
0.16 mg/L
value:
1 (1)
(Stawarz, Formicki
et al. 2007)
Polish women
Not reported
Not reported
Mature milk (12
weeks postpartum)
Yes: no information
on supplementation
Voltametric
method
Mean
±
SD
(range): 17.94 ±
7.07 (4.42-38.61)
mg/kg (not taken
into account in the
weighted
mean
analysis
because
conversion
was
undoable)
5 (210)
(O'Brien, Krebs et
al. 2007)
96% Caucasians
Yes: 16 of the 26
women received 15
mg
zinc
supplement all the
study long
Dietary zinc intake
(mean ± SD): 26.1
± 1.0 mg/d for
women
supplemented, 12.8
± 1.4 mg/d for nonsupplemented
women
Mature milk (0.5
month postpartum)
No
AAS
Mean ± SD: 3.70 ±
1.00 mg/L
26 (26)
EFSA supporting publication 2014:EN-629
Mature milk
months
postpartum)
(3
Mean ± SD: 1.50 ±
0.80 mg/L
Mature milk
months
postpartum)
(5
Mean ± SD: 1.20 ±
0.70 mg/L
Mature
months
(7
Mean ± SD: 0.80 ±
0.50 mg/L
milk
33
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Publication
Population main
characteristics
Supplementation
with the nutrient
of interest?
Maternal zinc
intake
Stage of lactation
Confounding
factors?
Analytical
method
Zinc
concentration in
breast milk
Number of
women (number
of samples)
postpartum)
(Almeida, Lopes et
al. 2008)
Study conducted in
Portugal, mother of
both term and
preterm infants
Not reported
Not reported
Colostrum (2 days
postpartum)
Yes: no information
on supplementation
(Mandato, Rubegni
et al. 2009)
Mother of preterm
infant
Not reported
Not reported
Not reported
Yes:
low
representativity of
the results (1 case)
(Yalcn, Baykan et
al. 2009)
Study conducted in
Turkey, mothers of
term infants
No
Not reported
Not reported
(Hannan, Faraji et
al. 2009)
Mexican-American
women
No
Not reported
Mature milk (30-45
days postpartum)
ICP-MS
Mean ± SD: 12.14
± 4.71 mg/L
34 (34)
Mean ± SD: 2.79 ±
1.21 mg/L
19 (19)
Not reported
Individual
0.05 mg/L
1 (1)
No
AAS
Mean
±
SD
(median): 4.78 ±
1.83 (4.5) mg/L
47 (47)
No
FAAS
Mean ± SD: 2.1 ±
1.4 mg/L
31 (30)
Mean ± SD: 2.0 ±
1.7 mg/L
17 (17)
Mean ± SD: 4.01 ±
1.18 mg/kg ((not
taken into account
in the weighted
mean
analysis
because conversion
was undoable)
31 (155 - samples
were collected 5
times from each
subject: after 1, 4,
8, 12 and 16 weeks
of giving birth)
Mature milk (1
month postpartum)
Mature milk (75-90
days postpartum)
(Matos, Moutinho
et al. 2009)
Study performed in
Portugal
Not reported
Not reported
Transitional
(7
postpartum)
milk
days
Mature milk (4
weeks postpartum
EFSA supporting publication 2014:EN-629
Yes: no information
on supplementation
ICP-MS
data:
Mean ± SD: 2.16 ±
0.59 mg/kg ((not
taken into account
34
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Publication
Population main
characteristics
Supplementation
with the nutrient
of interest?
Maternal zinc
intake
Stage of lactation
Confounding
factors?
Analytical
method
Zinc
concentration in
breast milk
Number of
women (number
of samples)
in the weighted
mean
analysis
because conversion
was undoable)
(Yalcin, Yurdakok
et al. 2010)
Study performed in
Turkey, mothers of
term infants
Not reported
EFSA supporting publication 2014:EN-629
Not reported
Mature milk (8
weeks postpartum
Mean ± SD: 1.49 ±
0.62 mg/kg ((not
taken into account
in the weighted
mean
analysis
because conversion
was undoable)
Mature milk (12
weeks postpartum
Mean ± SD: 1.08 ±
0.54 mg/kg ((not
taken into account
in the weighted
mean
analysis
because conversion
was undoable)
Mature milk (16
weeks postpartum
Mean ± SD: 1.01 ±
0.46 µg/kg ((not
taken into account
in the weighted
mean
analysis
because conversion
was undoable)
Mixed (10-20 days
postpartum)
Yes: no information
on supplementation
AAS
Mean
±
SD
(range): 4.78 ±
1.83 (1.5-9.0) mg/L
44
35
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Publication
Population main
characteristics
Supplementation
with the nutrient
of interest?
Maternal zinc
intake
Stage of lactation
Confounding
factors?
Analytical
method
Zinc
concentration in
breast milk
(Gass, Hafiji et al.
2010)
Not reported
Not reported
Not reported
Not reported
Yes:
low
representativity of
the results (1 case)
Not reported
Individual
0.44 mg/L
(Orun,
Songul
Yalcin et al. 2012)
Study performed in
Turkey, mothers of
both term and
preterm infants
Not reported
Not reported
Mature milk (52-60
days postpartum)
Yes: no information
on supplementation
ICP-MS
Median
(1st-3rd
quartiles):
0.63
(0.48-0.89) mg/L
142 (not reported)
(Bjorklund, Vahter
et al. 2012)
Study performed in
Sweden
Not reported
Not reported
Mature milk (14-21
days postpartum)
Yes: no information
on supplementation
ICP-MS
Mean
±
SD
(median / range):
3.47
±
0.98
(3.52/1.24-5.71)
mg/L
60 (60)
(Milacic, Ajlec et
al.)
Not reported
Not reported
Not reported
Mature milk (16
weeks postpartum)
Yes: no information
on supplementation
FAAS, ICP-MS
Mean ± SD: 3.93 ±
0.11 mg/L
1 (not reported)
(Miletta, Bieri et al.
2013)
Mother
infant
of
term
Not reported
EFSA supporting publication 2014:EN-629
Not reported
data:
Number of
women (number
of samples)
Mature milk (26
weeks postpartum)
Mean ± SD: 3.06 ±
0.08 mg/L
Mature milk (8
weeks postpartum)
Mean ± SD: 1.82 ±
0.02 mg/L
Mature milk (26
weeks postpartum)
Mean ± SD: 1.12 ±
0.02 mg/L
Not reported
Yes:
low
representativity of
the results (1 case)
Not reported
Individual
data:
0.12 mg/kg (not
taken into account
in the weighted
mean
analysis
because conversion
1
1 (1)
36
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Publication
Population main
characteristics
Supplementation
with the nutrient
of interest?
Maternal zinc
intake
Stage of lactation
Confounding
factors?
Analytical
method
Zinc
concentration in
breast milk
Number of
women (number
of samples)
was undoable)
(Bieri, Petkovic et
al. 2013)
Not reported
Not reported
Not reported
Not reported
Yes:
low
representativity of
the result (1 case)
Not reported
Individual
data:
0.12 mg/kg (not
taken into account
in the weighted
mean
analysis
because conversion
was undoable)
1
(WiniarskaMieczan, 2014)
Study performed in
Poland
Not reported
Not reported
Mature milk (1-12
months)
Yes: No information
on supplementation
FAAS
Mean
(range):
323 (323)
±
SD
Zinc: 1.62 ± 1.76
(0.043-8.16) mg/L
Weighted mean analysis for zinc concentration in women milk:
Mothers of preterm infants (weighted mean ± SE (95% CI)): 0.47 ± 0.04 mg/L (0.39 – 0.55) (6 studies)
Mothers of term infants (weighted mean ± SE (95% CI)): 2.51 ± 0.10 mg/L (2.32 – 2.71) (3 studies)
Colostrum (weighted mean ± SE (95% CI)): 8.60 ± 1.82 mg/L (5.03 – 12.17) (1 study)
Transitional milk (weighted mean ± SE (95% CI)): 2.72 ± 0.20 mg/L (2.33 – 3.11) (1 study)
Mature milk (weighted mean ± SE (95% CI)): 2.48 ± 0.01 mg/L (1.46 – 1.51) (1 study)
All samples (weighted mean ± SE (95% CI)): 2.06 ± 0.01 mg/L (2.05 – 2.07) (36 studies)
(a)
AAS (Atomic Absorption Spectrometry) vs. FAAS (Flame Atomic Absorption Spectrometry). AAS is a more general term than FAAS. Among other methods of AAS methods
stands out: ETAAS (Electrothermal Atomic Absorption Spectrometry) and CVAAS (Cold Vapor Atomic Absorption Spectrometry).
EFSA supporting publication 2014:EN-629
37
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Forty-one studies, reported in 42 papers, reported zinc concentration in breast milk. Six studies were free of confounders (Silvestre, Lagarda et al. 2000; Turan,
Saygi et al. 2001; Elmastas, Can et al. 2005; Leotsinidis, Alexopoulos et al. 2005; O'Brien, Krebs et al. 2007; Yalcn, Baykan et al. 2009; Hannan, Faraji et al.
2009). For zinc determination, the analytical method used is mainly atomic absorption spectrometry (25 studies); ICP-MS is used in 6 studies; voltammetry is used
in 1 study. Ten studies did not report the analytical method for zinc dosage. Milks were collected from mothers who gave birth to term (3 studies) and preterm (6
studies) infants, while in the other studies the gestational age was mixed/unspecified (27 studies). Milk samples from women of term infants included colostrum (1
study), transitional milk (1 study), mature milk (1 study) or mixed/unspecified samples (2 studies). The intake of zinc supplements was not reported in any study.
Zinc intake was assessed in 4 studies (Gulson, Mizon et al. 2001; Piotrowska-Dept, Piotrowska-Jastrzebska et al. 2006; O'Brien, Krebs et al. 2007; Hannan, Faraji
et al. 2009). Zinc status (defined as plasma zinc concentration) was assessed in 8 studies (Wasowicz, Gromadzinska et al. 2001; Guillot, Roth et al. 2003; Domellof,
Hernell et al. 2004; Almeida, Lopes et al. 2008; Mandato, Rubegni et al. 2009; Gass, Hafiji et al. 2010; Yalcin, Yurdakok et al. 2010; Bieri, Petkovic et al. 2013).
The weighted mean and 95% CI zinc concentration from all samples was 2.06 (2.05 – 2.07) mg/L. The weighted mean analysis shows high levels of zinc in
colostrum (weighted mean and 95% CI: 8.60 (5.03 – 12.17) mg/L), then these levels decrease for transitional milk (weighted mean and 95% CI: 2.72 (2.33 – 3.11)
mg/L) and mature milk (weighted mean and 95% CI: 1.48 (1.46 – 1.51) mg/L). Mothers of term infants had a 5-fold higher breast milk zinc concentration
(weighted mean and 95% CI: 2.51 (2.32 – 2.71) mg/L) than mothers of preterm infants (weighted mean and 95% CI: 0.47 (0.39 – 0.55) mg/L).
Two studies showed no significant correlation between milk zinc concentration and maternal plasma zinc (Domellof, Hernell et al. 2004; Gass, Hafiji et al. 2010).
Another study found no relationship between zinc dietary intake and breast milk concentration (Hannan, Faraji et al. 2009). The relationship between zinc
intake/status and breast milk concentration was not investigated in the other studies.
4.3.
Vitamin B6, Vitamin E, choline, phosphorus, potassium
4.3.1.
Vitamin B6
As described in the study flow diagram, 4 publications, all from the USA, were included from the comprehensive literature search on vitamin B6, providing data on
composition for “vitamin B6” (2 studies), pyridoxal (2 studies), pyridoxamine and pyridoxine (1 study) (January 2000 – January 2014). Details are reported in the
following Table 4.
EFSA supporting publication 2014:EN-629
38
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Table 4:
Summary of the included studies for vitamin B6
Publication
Population main
characteristics
(Lovelady,
Williams et al.
2001)
American women:
Non-Hispanic
White (n=8), Black
(n=3)
Mothers of term
infants
Supplementation
Yes: All women
were given a
multivitamin
supplement which
contained 2.0 mg
vitamin B6
(pyridoxine-HCl
form)
Maternal
micronutrients intake
Stage of lactation
Confounding
factors
No
Analytical
method
microbiologic
al assay (using
Saccharomyce
s uvarum)
“Vitamin B6”
concentration in
breast milk (a)
Weight loss group:
Dietary vitamin B6
intake:
Mature milk:
2.7 ± 0.6 mg/day
(baseline),
4-6 weeks
(baseline),
146.85 ± 14.89 µg/L
(baseline),
1.9 ± 0.2 mg/day
(midpoint),
9-11 weeks
(midpoint),
179.67 ± 19.46µg/L
(midpoint),
1.8 ± 0.3 mg/day (end);
14-16 weeks
(endpoint)
174.09 ± 18.95 µg/L
(end)
Weight loss group
Vitamin B6 (mean ±
SE):
Number of
women
(number of
samples)
Weight loss
group: 11 (11)
Total vitamin B6 intake:
4.5 ± 0.6 mg/day
(baseline),
3.8 ± 0.2 mg/day
(midpoint),
3.8 ± 0.3 mg/day (end)
Control group:
Dietary vitamin B6
intake:
2.2 ± 0.1 mg/day
(baseline),
Control group:
Vitamin B6 (mean ±
SE): 1
Control
group: 10 (10)
141.10 ± 12.86 µg/L
(baseline),
161.23 ± 18.61 µg/L
1.9 ± 0.2 mg/day
EFSA supporting publication 2014:EN-629
39
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Publication
Population main
characteristics
Supplementation
Maternal
micronutrients intake
Stage of lactation
Confounding
factors
Analytical
method
“Vitamin B6”
concentration in
breast milk (a)
(midpoint),
(midpoint),
1.8 ± 0.2 mg/day (end);
173.41 ± 19.46 µg/L
(end)
Number of
women
(number of
samples)
Total vitamin B6 intake:
4.0 ± 0.3 mg/day
(baseline),
3.9 ± 0.2 mg/day
(midpoint),
3.8 ± 0.2 mg/day (end)
(Boylan, Hart et
al. 2002)
USA: White (16),
African-American
(2), Hispanic (6),
other (1)
All were mothers of
term infants
Yes, with undefined
nutrients. Among
the 25 subjects, 2:
no any vitamin
supplements, 5:
vitamin
supplements
(prenatal vitamins
or a multivitamin
mineral
supplement) every
other day. All other
subjects reported
daily supplement
use.
Vitamin B6 intake (from
food and supplements),
mean ± SD (median;
range): 3.47 ± 1.36 (2.90;
1.22 - 7.18) mg/day.
Only 1 subject had an
intake of vitamin B6
below the RDA for
lactation of 2.0 mg/day.
Transitional milk
(8-11 days
postpartum)
No
HPLC (highperformance
liquid
chromatograp
hy)
Mean ± SD (median;
range):
Pyridoxal: 25
(25)
Pyridoxal: 70.21 ±
50.15 (55.16; 20.06 –
215.64) µg/L
Pyridoxamine
(when levels
were
detectable): 21
(21)
Pyridoxamine: 10.09 ±
10.09 (8.41; 1.68 –
40.60) µg/L
Pyridoxine: 10.15 ±
3.38 (10.15; 6.77 –
13.53) µg/L
Pyridoxine
(when levels
were
detectable): 3
(3)
No phosphorylated
forms of the B-6
vitamers were detected
in any of the breast
EFSA supporting publication 2014:EN-629
40
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Publication
Population main
characteristics
Supplementation
Maternal
micronutrients intake
Stage of lactation
Confounding
factors
Analytical
method
“Vitamin B6”
concentration in
breast milk (a)
Number of
women
(number of
samples)
milk samples
(Chang and
Kirksey 2002)
Study performed in
USA with mothers
of term infants
Yes: vitamin B6 as
PNxHCl 2.5 mg
Total intake of vitamin
B6: 4.1 ± 0.2 mg/d
Yes: vitamin B6 as
PNxHCl 4.0 mg
Vitamin B6 (mean ±
SE): 150.74 ± 5.06
µg/L
11 (11)
Total intake of vitamin
B6: 6.2 ± 0.2 mg/d
Vitamin B6 (mean ±
SE): 200.31 ± 8.59
µg/L
15 (15)
Yes: vitamin B6 as
PNxHCl 7.5 mg
Total intake of vitamin
B6: 9.1 ± 0.2 mg/d
Vitamin B6 (mean ±
SE): 296.42 ± 14.67
µg/L
10 (10)
Yes: vitamin B6 as
PNxHCl 10 mg
Total intake of vitamin
B6: 11.5 ± 0.4 mg/d
Vitamin B6 (mean ±
SE): 288.33 ± 6.58
µg/L
10 (10)
Yes: vitamin B6 as
PNxHCl 2.5 mg
Total intake of vitamin
B6: 3.9 ± 0.2 mg/d
Vitamin B6 (mean ±
SE): 200.31 ± 5.57
µg/L
9 (9)
Yes: vitamin B6 as
PNxHCl 4.0 mg
Total intake of vitamin
B6: 6.3 ± 0.3 mg/d
Vitamin B6 (mean ±
SE): 293.39 ± 10.62
µg/L
16 (16)
Yes: vitamin B6 as
PNxHCl 7.5 mg
Total intake of vitamin
B6: 8.7 ± 0.2 mg/d
Vitamin B6 (mean ±
SE): 336.89 ± 13.65
µg/L
10 (10)
Yes: vitamin B6 as
Total intake of vitamin
Vitamin B6 (mean ±
SE): 375.34 ± 16.70
11 (11)
EFSA supporting publication 2014:EN-629
Mature milk (1
month)
Mature milk (2
months)
No
microbiologic
al assay (using
Saccharomyce
s uvarum)
41
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Publication
Population main
characteristics
Supplementation
Maternal
micronutrients intake
PNxHCl 10 mg
B6: 11.3 ± 0.2 mg/d
Yes: vitamin B6 as
PNxHCl 2.5 mg
Total intake of vitamin
B6: 4.4 ± 0.5 mg/d
Yes: vitamin B6 as
PNxHCl 4.0 mg
Stage of lactation
Confounding
factors
Analytical
method
“Vitamin B6”
concentration in
breast milk (a)
Number of
women
(number of
samples)
µg/L
Vitamin B6 (mean ±
SE): 212.46 ± 9.61
µg/L
10 (10)
Total intake of vitamin
B6: 5.9 ± 0.1 mg/d
Vitamin B6 (mean ±
SE): 271.13 ± 9.10
µg/L
16 (16)
Yes: vitamin B6 as
PNxHCl 7.5 mg
Total intake of vitamin
B6: 8.9 ± 0.2 mg/d
Vitamin B6 (mean ±
SE): 357.12 ± 8.09
µg/L
10 (10)
Yes: vitamin B6 as
PNxHCl 10 mg
Total intake of vitamin
B6: 11.3 ± 0.2 mg/d
Vitamin B6 (mean ±
SE): 384.44 ± 20.23
µg/L
11(11)
Yes: vitamin B6 as
PNxHCl 2.5 mg
Total intake of vitamin
B6: 3.7 ± 0.1 mg/d
Vitamin B6 (mean ±
SE): 205.37 ± 8.09
µg/L
7 (7)
Yes: vitamin B6 as
PNxHCl 4.0 mg
Total intake of vitamin
B6: 5.9 ± 0.2 mg/d
Vitamin B6 (mean ±
SE): 321.71 ± 10.12
µg/L
16 (16)
Yes: vitamin B6 as
PNxHCl 7.5 mg
Total intake of vitamin
B6: 8.5 ± 0.1 mg/d
Vitamin B6 (mean ±
SE): 407.71 ± 15.68
µg/L
10 (10)
Yes: vitamin B6 as
Total intake of vitamin
Vitamin B6 (mean ±
SE): 487.64 ± 27.83
10 (10)
EFSA supporting publication 2014:EN-629
Mature milk (3
months)
Mature milk (4
months)
42
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Publication
Population main
characteristics
Supplementation
Maternal
micronutrients intake
PNxHCl 10 mg
B6: 11.2 ± 0.2 mg/d
Yes: vitamin B6 as
PNxHCl 2.5 mg
Total intake of vitamin
B6: 3.6 ± 0.2 mg/d
Yes: vitamin B6 as
PNxHCl 4.0 mg
Stage of lactation
Confounding
factors
Analytical
method
“Vitamin B6”
concentration in
breast milk (a)
Number of
women
(number of
samples)
µg/L
Vitamin B6 (mean ±
SE): 201.32 ± 8.59
µg/L
5 (5)
Total intake of vitamin
B6: 5.9 ± 0.2 mg/d
Vitamin B6 (mean ±
SE): 330.83 ± 13.15
µg/L
13 (13)
Yes: vitamin B6 as
PNxHCl 7.5 mg
Total intake of vitamin
B6: 8.8 ± 0.2 mg/d
Vitamin B6 (mean ±
SE): 401.65 ± 15.18
µg/L
10 (10)
Yes: vitamin B6 as
PNxHCl 10 mg
Total intake of vitamin
B6: 11.2 ± 0.2 mg/d
Vitamin B6 (mean ±
SE): 465.38 ± 21.76
µg/L
8 (8)
Yes: vitamin B6 as
PNxHCl 2.5 mg
Total intake of vitamin
B6: 6.0 ± 0.2 mg/d
Vitamin B6 (mean ±
SE): 222.57 ± 12.65
µg/L
4 (4)
Yes: vitamin B6 as
PNxHCl 4.0 mg
Total intake of vitamin
B6: 9.0 ± 0.2 mg/d
Vitamin B6 (mean ±
SE): 328.80 ± 12.65
µg/L
12 (12)
Yes: vitamin B6 as
PNxHCl 7.5 mg
Total intake of vitamin
B6: 11.0 ± 0.1 mg/d
Vitamin B6 (mean ±
SE): 385.46 ± 14.67
µg/L
10 (10)
Yes: vitamin B6 as
Total intake of vitamin
Vitamin B6 (mean ±
SE): 395.56 ± 17.71
6 (6)
EFSA supporting publication 2014:EN-629
Mature milk (5
months)
Mature milk (6
months)
43
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Publication
Population main
characteristics
(Hampel, York et
al. 2012)
Caucasian women
(from USA)
Supplementation
Maternal
micronutrients intake
PNxHCl 10 mg
B6: 4.1 ± 0.2 mg/d
Not reported
Not reported
Stage of lactation
Confounding
factors
Analytical
method
“Vitamin B6”
concentration in
breast milk (a)
Number of
women
(number of
samples)
µg/L
Mature milk: 4-12
weeks
Yes: Few
information on
population and
lack of
information on
specific
supplementation
UPLCMS/MS)
(ultraperformance
liquid
chromatograp
hy tandem
massspectrometry)
pyridoxal (median
(range)): 29 (6-82)
µg/L
28 (28)
Weighted mean analysis for total vitamin B6 concentration in women milk (3 studies):
All samples dealing with total vitamin B6 concentration (mature milk from supplemented mothers of term infants) (weighted mean ± SE (95% CI)): 244.14 ± 5.96 µg/L (232.45
– 255.83) (2 studies)
All samples dealing with both total vitamin B6 concentration and sum of pyridoxal, pyridoxamine and pyridoxine (mature and transitional milks from supplemented mothers of
term infants) (weighted mean ± SE (95% CI)): 233.15 ± 5.75 µg/L (221.89 – 244.42) (3 studies)
(a)
Total vitamin B6 concentrations are reported. Concentrations in individual forms pyridoxal, pyridoxamine and pyridoxine are reported, when available.
EFSA supporting publication 2014:EN-629
44
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Four studies reported concentration of total vitamin B6 (2 studies) or individual forms of vitamin B6 (pyridoxal, pyridoxine, pyridoxamine) (2 studies) in breast
milk. Three studies were free of confounders (Lovelady, Williams et al. 2001; Boylan, Hart et al. 2002; Chang and Kirksey 2002). Total vitamin B6 was measured
via microbiological assays (2 studies); pyridoxal (2 studies), pyridoxamine (1 study) and pyridoxine (1 study) were measured via HPLC-MS/MS. Milk samples
included transitional milk (1 study) and mature milk (3 studies). Three studies involved mothers of term infants while the length of gestation was not specified in 1
other study. In two of the studies, mothers were taking vitamin B6 supplements (pyridoxine-HCl form, 2 – 10 mg) (Lovelady, Williams et al. 2001; Chang and
Kirksey 2002); in one study mothers were taking multivitamins supplement of undefined concentration (Boylan, Hart et al. 2002) and in one study supplementation
was not reported (Hampel, York et al. 2012). Three studies reported intake data (total vitamin B6 intake of 3.47 to 11.5 mg/day) (Lovelady, Williams et al. 2001;
Boylan, Hart et al. 2002; Chang and Kirksey 2002); 1 reported data on mothers’ status (defined as plasma total vitamin B6 concentration) (Lovelady, Williams et
al. 2001). From data on infant status, Chang and Kirksey 2002 showed that a maternal pyridoxine-HCl supplement of 2.5 mg/day provided an adequate amount of
vitamin B6 in breast milk (0.15 mg/day) for the vitamin B6 status parameters and the growth of breast-fed infants.
All analyses on total vitamin B6 concentration were performed on mature milk samples from women supplemented with vitamin B6 who gave birth to term infants
(2 studies) (weighted mean and 95% CI: 244.14 (232.45 – 255.83) µg/L). An additional study reported total vitamin B6 concentration as the sum of pyridoxal,
pyridoxamine and pyridoxine. Samples were transitional milk; women were mothers of term infants and were mostly supplemented with undefined nutrients. The
weighted mean and 95% CI for total vitamin B6 concentration from all samples coming from these 3 studies was 233.15 (221.89 – 244.42) µg/L.
One study reported that mothers with vitamin B6 intake greater than the median value had a significantly higher median pyridoxal level in their breast milk than did
the mothers with intakes below the median value (Boylan, Hart et al. 2002), while the relationship was not investigated in the 3 other studies.
EFSA supporting publication 2014:EN-629
45
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
4.3.2.
Vitamin E
As described in the study flow diagram, 24 publications (23 studies with the Gossage et al. study reported in 2 references) were included from the comprehensive
literature search on “total vitamin E” or tocopherols (alpha-, beta-, delta-, gamma-, individually and/or sums of them) (January 2000 – January 2014). Twenty
studies are from Europe, 3 studies are from North America. Details are reported in the following Table 5.
Table 5:
Publication
(Gossage,
Deyhim et al.
2000; Gossage,
Deyhim et al.
2002)
Summary of the included studies for vitamin E
Population main
characteristics
Supplementation
Maternal
micronutrients intake
European American
(n=17), Hispanic
(n=2), African
American (n=2)
Yes, but with other
nutrient: Betacarotene group with
30 mg/day betacarotene
Beta-carotene group:
dietary intakes (mean ±
SD)
No: Placebo group
Placebo group: dietary
intakes (mean ± SD)
Stage of lactation
Colostrum: 4 days
postpartum
Vitamin E: 7.0 ± 4.5 mg
Vitamin E: 7.0 ± 3.8 mg
Confounding
factors
No
Analytical
method
HPLC
“Vitamin E”
concentration in
breast milk (a)
Both supplemented
and placebo groups
(mean ± SD):
alpha-tocopherol:
13.35 ± 1.98 mg/L
Mature milk: 32
days postpartum
Both supplemented
and placebo groups
(mean ± SD):
Number of
women
(number of
samples)
Beta-carotene
group: 10 (80
(8 samples per
woman))
Placebo
group: 9 (72
(8 samples per
woman))
alpha-tocopherol: 4.05
±
0.52 mg/L
EFSA supporting publication 2014:EN-629
46
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
(Olafsdottir,
Wagner et al.
2001)
Study performed in
Iceland
Yes: cod liver oil
(no other
supplements)
No: no cod liver oil
group
Cod liver oil group
Mature milk: 2-4
months postpartum
Vitamin E daily intake:
9.0 ± 1.5 mg/day
Yes: lack of
information on
supplementation
of the nutrients of
interest (in the
article are
described only
data about cod
liver oil
supplementation)
HPLC
Both cod liver oil and
no cod liver oil groups
alpha-tocopherol (mean
± SE): 4.14 ± 0.20
mg/L
gamma-tocopherol
(mean ± SE): 1.03 ±
0.06 mg/L
tocopherol equivalents
TE (alpha-TE = alphatocopherol + 0.25
gamma-tocopherol)
(mean ± SE): 4.40 ±
0.21 mg/L
No cod liver oil group
Vitamin E daily intake:
6.0 ± 0.5 mg/day
(Thijssen, Drittij
et al. 2002)
Study performed in
Netherlands,
mothers of term
infants
Yes, with other
nutrient than the
one of interest
(phylloquinone: 0;
0.8; 2.0 or 4.0
mg/day)
Not reported
Colostrum: 4 days
Transitional milk: 8
days
Mature milk: 16
days
EFSA supporting publication 2014:EN-629
Yes: Few
information on
population
As this
calculation
method for
vitamin E as TE
(sum of alpha- +
gammatocopherols) is
used only once,
results were not
included in the
weighted mean
Cod liver oil
group: 18
(18)
HPLC
No cod liver
oil group: 59
(59)
Vitamin E as TE
(alpha- + gammatocopherol) (mean ±
SD): 11.41 ± 7.97
mg/L
31 (31)
Vitamin E as TE
(alpha- + gammatocopherols) (mean ±
SD): 5.77 ± 5.38 mg/L
29 (29)
Vitamin E as TE
(alpha- + gammatocopherols) (mean ±
SD): 3.36 ± 2.46 mg/L
28 (28)
47
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
(Jewell, Mayes et
al. 2004)
(Schweigert,
Bathe et al. 2004)
Study performed in
Ireland, Irish
women mothers of
both term and
preterm infants
Study performed in
Germany, mothers
of term infants
Not reported
No
Not reported
Not reported
Mature milk: 19
days
analyses
Mixed: 1-41 days
Yes: Few
information on
population and
lack of
information on
specific
supplementation
Modified
version of the
step gradientHPLC
methods
No
HPLC
Colostrum: 4 ± 2
days
Vitamin E as TE
(alpha- + gammatocopherols) (mean ±
SD): 3.23 ± 2.46 mg/L
28 (28)
Median (range):
13 (28)
alpha-tocopherol: 6.04
(1.2 – 41.05) µmol/g of
fat
gammatocopherol:0.52 (0.01 –
2.61) µmol/g of fat
Mature milk: 19 ± 2
days
Alpha-tocopherol
(colostrum) (mean ±
SD): 22.01 ± 13.40
mg/L
21 (21)
Alpha-tocopherol
(mature milk) (mean ±
SD): 5.69 ± 2.20 mg/L
(Quiles, Ochoa et
al. 2006)
Spanish women
mothers of pre-term
infants
No supplement
containing
antioxidant
vitamins or
coenzyme Q
Preterm group:
Vitamin E daily intake:
6.1 ± 2.4 mg
Colostrum: 3 days
No
HPLC
alpha-tocopherol
(mean): 16.37 mg/L
Preterm
group: 15 (15)
delta-tocopherol
(mean): 0.10 mg/L
gamma-tocopherol
(mean): 0.63 mg/L
EFSA supporting publication 2014:EN-629
48
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Transitional milk: 8
days
alpha-tocopherol
(mean): 9.04 mg/L
delta-tocopherol
(mean): 0.10 mg/L
gamma-tocopherol
(mean): 0.54 mg/L
Mature milk: 30
days
alpha-tocopherol
(mean): 5.17 mg/L
delta-tocopherol
(mean): 0.08 mg/L
gamma-tocopherol
(mean): 0.46 mg/L
Spanish women
mothers of term
infants
Full-term group:
Colostrum: 3 days
Vitamin E daily intake:
6.1 ± 0.9 mg
alpha-tocopherol
(mean): 24.55 mg/L
Full-term
group: 15 (15)
delta-tocopherol
(mean): 0.12 mg/L
gamma-tocopherol
(mean): 0.88 mg/L
Transitional milk: 8
days
alpha-tocopherol
(mean): 16.37 mg/L
delta-tocopherol
(mean): 0.12 mg/L
gamma-tocopherol
(mean): 0.79 mg/L
EFSA supporting publication 2014:EN-629
49
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Mature milk: 30
days
alpha-tocopherol
(mean): 8.61 mg/L
delta-tocopherol
(mean): 0.10 mg/L
gamma-tocopherol
(mean): 0.75 mg/L
(Romeu-Nadal,
Morera-Pons et al.
2006)
Spanish women
mothers of term
infants
Not reported
Not reported
Mature milk (no
data about number
of days)
Yes: Few
information on
population and
lack of
information on
specific
supplementation
Method I*
Method II*
Method III*
Alpha-tocopherol:
Method I* (mean ±
SD): 4.72 ± 0.17 mg/L
Not reported
Method II* (mean ±
SD): 3.71 ± 0.16 mg/L
Method III* (mean ±
SD): 3.72 ± 0.18 mg/L
Gamma-tocopherol:
Method I (mean ± SD):
0.43 ± 0.01mg/L
Method II (mean ±
SD): 0.33 ± 0.01 mg/L
(Romeu-Nadal,
Castellote et al.
2008)
Spanish women
Not reported
EFSA supporting publication 2014:EN-629
Not reported
Mature milk (no
data about number
of days)
Yes: Few
information on
population and
lack of
information on
specific
supplementation
HPLC
Alpha-tocopherol
(mean ± SD): 4.41 ±
0.16 mg/L
10 (20)
Gamma-tocopherol (
mean ± SD): 0.47 ±
0.02 mg/L
50
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
(Romeu-Nadal,
Castellote et al.
2008)
Spanish women
Not reported
Not reported
Mature milk (no
data about number
of days)
Yes: Few
information on
population and
lack of
information on
specific
supplementation
HPLC
Alpha-tocopherol (
mean ± SD): 3.85 ±
0.16 mg/L
10 (20)
Gamma-tocopherol (
mean ± SD): 0.37 ±
0.02 mg/L
(Michalski,
Calzada et al.
2008)
French women
Not reported
Not reported
Mature milk (mean
± SD): 6.1 ± 4.0
months
Yes: No
information on
supplementation
HPLC
Vitamin E as TE
(alpha- + gammatocopherols) ( mean ±
SD): 1.14 ± 0.52 mg/L
4 (4)
(Tokusoglu,
Tansug et al.
2008)
Turkish women
mothers of term
infants
Not reported
Not reported
Mature milk: 60-90
days
Yes: lack of
information on
specific
supplementation
HPLC
Alpha-tocopherol
(mean ± SD): 9.84 ±
2.13 mg/L
92 (92)
(Tijerina-Saenz,
Innis et al. 2009)
Canadian women
(Caucasian 73%)
mothers of term
infants
Yes, with
unspecified
nutrients: all
women reported
taking multivitamin
supplements
Not reported
Mature milk: 1
month postpartum
Yes: lack of
information on
specific
supplementation
HPLC
alpha-tocopherol (mean
± SE): 2.32 ± 0.11
mg/L
60 (60)
delta-tocopherol (mean
± SE): 0.11 ± 0.01
mg/L
gamma-tocopherol
(mean ± SE): 0.46 ±
0.03 mg/L
EFSA supporting publication 2014:EN-629
51
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
(Duda, NogalaKalucka et al.
2009)
Polish women
Not reported
Intake of vitamin E
(mean ± SD): 7.7 ± 3.4
mg/day.
Mature milk (~96%
of the inquired
women were breast
feeding for 2.5
month on the
average, range: 112 months)
Yes: lack of
information on
specific
supplementation
HPLC
Mean ± SD:
30 (30)
alpha-tocopherol: 4.11
± 3.48 mg/L
beta-tocopherol: 0.03 ±
0.02 mg/L
gamma-tocopherol:
0.31 ± 0.25 mg/L
alpha-tocopherol
equivalent (alpha-TE
(µg) = alphatocopherol (µg) + 0.5
beta-tocopherol (µg) +
0.25 gamma tocopherol (µg)
(Olafsdottir et al.,
2001)): 4.13 ± 1.94
mg/L
(Sziklai-Laszlo,
Majchrzak et al.
2009)
Hungarian women
mothers of term
infants
No
Not reported
Transitional milk:
5-10 days
Yes: Few
information on
population and
lack of
information on
dietary
micronutrients
intake
HPLC
Transitional milk
(mean ± SD): alphatocopherol: 4.14 ± 2.17
mg/L
Transitional
milk group:
12 (12)
gamma-tocopherol:
0.53 ± 0.28 mg/L
alpha-TE (α-TE (mg) =
α-tocopherol (mg) +
0.25 γ-tocopherol
(mg)): 4.27 ± 2.18
mg/L
EFSA supporting publication 2014:EN-629
52
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Mature milk: 2-40
weeks
Mature milk (mean ±
SD): alpha-tocopherol:
3 ± 1.16 mg/L
Mature milk
group: 18 (18)
gamma-tocopherol:
1.17 ± 0.44 mg/L
alpha-TE (tocopherol
equivalents): 3.3 ± 1.13
mg/L
(Molto-Puigmarti,
Castellote et al.
2009)
Spanish women
Not reported
Not reported
Colostrum
Yes: lack of
information on
specific
supplementation
and population
Ultra
Performance
Liquid
Chromatograp
hic System
Colostrum (mean ±
SD):
10 (10)
alpha-tocopherol:
37.84 ± 24.52 mg/L
beta + gamma
tocopherols: 0.9 ± 0.53
mg/L
delta-tocopherol: 0.14
± 0.09 mg/L
Mature milk
Mature milk (mean ±
SD):
alpha-tocopherol: 3.39
± 2.12 mg/L
beta + gamma
tocopherol: 0.23 ± 0.17
mg/L
delta-tocopherol: 0.03
± 0.03 mg/L
EFSA supporting publication 2014:EN-629
53
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
(Orhon, Ulukol et
al. 2009)
(Molto-Puigmarti,
Permanyer et al.
2011)
Non-smoker
Turkish women
mothers of term
infants
No
Total “vitamin A +
retinol” (mean (SEM)):
4965.2 (538.5) IU/day
Transitional milk (7
days)
No
HPLC
alpha-tocopherol (mean
± SEM): 13.27 ± 0.69
mg/L
20 (20)
Smoker Turkish
women mothers of
term infants
No
Total “vitamin A +
retinol” (mean (SEM)):
4669.0 (358.3) IU/day
Transitional milk (7
days)
No
HPLC
alpha-tocopherol (mean
± SEM): 9.99 ± 1.08
mg/L
20 (20)
Spanish women
Not reported
Not reported
Mature milk
Yes: lack of
information on
specific
supplementation
and population
UHPLC
alpha-tocopherol (mean
± SD): 7.17 ± 2.6 mg/L
10 (10)
delta-tocopherol (mean
± SD): 0.1 ± 0.09 mg/L
gamma-tocopherol
(mean ± SD): 0.48 ±
0.28 mg/L
(Antonakou,
Chiou et al. 2011)
Greek women
mothers of term
infants
No (mothers were
not receiving any
vitamin E
supplements during
their pregnancy or
postpartum)
EFSA supporting publication 2014:EN-629
Dietary intake of vitamin
E (mean ± SD): 7.2 ± 3.7
mg/day
Mature milk at
several time points
post-partum:
group I: 1 month
(20-30 days)
Yes: lack of
information on
specific
supplementation
As this
calculation
method for
vitamin E as TE
(sum of alpha-,
(beta- and
gamma-) and
delta- tocopherol)
is used only once,
results were not
included in the
weighted mean
HPLC
Group I (mean ± SD):
I group: 64
(64)
alpha-tocopherol: 3.57
± 1.46 mg/L
beta- and gammatocopherol: 0.25 ± 0.14
mg/L
delta-tocopherol: 0.01
± 0.02 mg/L
total vitamin E (sum of
alpha-, (beta and
gamma)- and deltatocopherol): 3.83 ±
1.55 mg/L
54
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
group II: 3 months
analyses
Group II (mean ± SD):
II group: 39
(39)
alpha-tocopherol: 3.49
± 1.81 mg/L
beta- and gammatocopherol: 0.32 ± 0.20
mg/L
delta-tocopherol: 0.01
± 0.01 mg/L
total vitamin E (sum of
alpha-, (beta and
gamma)- and deltatocopherol): 3.75 ±
1.55 mg/L
group III: 6 months
Group III (mean ± SD):
III group: 23
(23)
alpha-tocopherol: 3.66
± 2.02 mg/L
beta- and gammatocopherol: 0.43 ± 0.52
mg/L
delta-tocopherol: 0.01
± 0.01 mg/L
total vitamin E (sum of
alpha-, (beta and
gamma)- and deltatocopherol): 4.09 ±
2.41 mg/L
EFSA supporting publication 2014:EN-629
55
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
(Elisia and Kitts
2011)
Canadian women
Not reported
Not reported
Mature milk: > 2
weeks
HPLC
alpha-tocopherol (mean
± SD): 2.11 ± 0.66
mg/L
30 (30)
delta-tocopherol (mean
± SD): 0.14 ± 0.07
mg/L
gamma-tocopherol
(mean ± SD): 0.8 ±
0.28 mg/L
(Kasparova,
Plisek et al. 2012)
Czech women
Not reported
Not reported
Mature milk: 1-2
months
Yes: No
information on
supplementation
HPLC
Alpha-tocopherol
(mean ± SD):
12 (12)
Mature milk (1-2
months) group: 3.96 ±
1.42 mg/L
EFSA supporting publication 2014:EN-629
Mature milk: 3-4
months
Mature milk (3-4
months) group: 3.75 ±
1.68 mg/L
Mature milk: 5-6
months
Mature milk (5-6
months) group: 3.62 ±
1.51 mg/L
Mature milk: 9-12
months
Mature milk (9-12
months) group: 4.01 ±
1.34 mg/L
56
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
(SzlagatysSidorkiewicz,
Zagierski et al.
2012)
(MartysiakZurowska,
SzlagatysSidorkiewicz et
al. 2013)
Polish women
mothers of term
infants
Polish women
Yes: vitamin
supplementation
Not reported
Colostrum: 3rd day
Mature milk: 30th32nd day
postpartum
Yes: vitamin E
daily intake from
supplementation
(mean ± SD
(range)): 7.32 ±
8.34 (0 – 30)
mg/day
Colostrum group: no
data
Colostrum: 2nd day
postpartum
Yes: lack of
details on vitamin
supplementation
HPLC
As the calculation
for “vitamin E”
was not reported,
values were not
included in the
weighted mean
analyses.
No
“Vitamin E”
(calculation not
reported) (median
(range)):
49 (49)
Colostrum: 8.86 (5.2212.0) mg/L
Transitional milk: 1.1
(0.74-3.94) mg/L
HPLC
Alpha-tocopherol
(mean ± SD): 9.99 ±
1.51 mg/L
Colostrum
group: 17
(17)
Gamma-tocopherol
(mean ± SD): 0.57 ±
0.21 mg/L
TE (alpha-tocopherol
equivalents defined as
TE (mg) = alphatocopherol (mg) + 0.25
gamma-tocopherol
(mg)) ( mean ± SD):
10.13 ± 1.5 mg/L
EFSA supporting publication 2014:EN-629
57
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Transitional milk
group: Daily intake of
alpha-tocopherol
equivalents (mean ± SD
(range)): 8.20 ± 3.40
(4.24 - 16.67) mg/day
Transitional milk:
14th day postpartum
Alpha-tocopherol
(mean ± SD): 4.45 ±
0.95 mg/L
Transitional
milk group:
30 (30)
Gamma-tocopherol
(mean ± SD): 0.6 ±
0.21 mg/L
TE (alpha-tocopherol
equivalents defined as
TE (mg) = alphatocopherol (mg) + 0.25
gamma-tocopherol
(mg)) ( mean ± SD):
4.59 ± 0.93 mg/L
Mature milk group (30
days): Daily intake of
alpha-tocopherol
equivalents (mean ± SD
(range)): 8.41 ± 3.48
(3.43 - 16.08) mg/day
Mature milk: 30th
day postpartum
Alpha-tocopherol
(mean ± SD): 2.92 ±
0.84 mg/L
Mature milk
group (30
days): 27 (27)
Gamma-tocopherol
(mean ± SD): 0.3 ±
0.14 mg/L
TE (alpha-tocopherol
equivalents defined as
TE (mg) = alphatocopherol (mg) + 0.25
gamma-tocopherol
(mg)) ( mean ± SD):
3.0 ± 0.85 mg/L
EFSA supporting publication 2014:EN-629
58
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Mature milk group (90
days): Daily intake of
alpha-tocopherol
equivalents (mean ± SD
(range)): 9.33 ± 3.80
(4.00 - 15.76) mg/day
Mature milk: 90th
day postpartum
Alpha-tocopherol
(mean ± SD): 2.07 ±
0.66 mg/L
Mature milk
group (90
days): 19 (19)
Gamma-tocopherol
(mean ± SD): 0.22 ±
0.1 mg/L
TE (alpha-tocopherol
equivalents defined as
TE (mg) = alphatocopherol (mg) + 0.25
gamma-tocopherol
(mg)) ( mean ± SD):
2.13 ± 0.67 mg/L
(Vahamiko,
Isolauri et al.
2013)
Finnish women
(Caucasian)
mothers of term
infants
Yes: Vitamin E
from supplements
(mean (95% CI)):
4.91 (3.23 - 6.58)
mg
Vitamin E from diet
(mean (95% CI)): 11.83
(10.93 - 12.73) mg
Colostrum
Mature milk: 1
month
Vitamin E from
supplements (mean
(95% CI)): 5.65
(3.95-7.34) mg
EFSA supporting publication 2014:EN-629
Vitamin E from diet
(mean (95% CI)): 9.88
(8.99 – 10.77) mg
Colostrum
Population allergy (fever,
asthma, atopic
eczema or food
allergy) in the
family (mother,
father or sibling
of unborn child).
As the calculation
for “vitamin E”
was not reported,
values were not
included in the
weighted mean
analyses.
HPLC
“Vitamin E”
(calculation not
reported) (mean (95%
CI)): 16.54 (13.71 –
19.98) mg/L
Intervention
group - with
individual
dietary
counselling:
44 (44)
“Vitamin E”
(calculation not
reported) (mean (95%
CI)): 3.56 (3.05 – 4.16)
mg/L
“Vitamin E”
(calculation not
reported) (mean (95%
CI)): 12.96 (9.96 –
16.87) mg/L
Control
group: 45 (45)
59
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Mature milk: 1
month
EFSA supporting publication 2014:EN-629
“Vitamin E”
(calculation not
reported) (mean (95%
CI)): 3.41 (2.92 – 3.98)
mg/L
60
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Weighted mean analysis for total vitamin E expressed as tocopherol-equivalent (TE (mg) = alpha-tocopherol (mg) + 0.25 gamma-tocopherol (mg)) in women milk (5 studies):
Mothers of term infants (weighted mean ± SE (95% CI)): 3.51 ± 1.00 mg/L (1.54 – 5.47) (1 study)
Transitional milk (weighted mean ± SE (95% CI)): 4.27 ± 2.18 mg/L (0.01 – 8.54) (1 study)
Mature milk (weighted mean ± SE (95% CI)): 3.30 ± 1.13 mg/L (1.09 – 5.51) (1 study)
Supplemented women (weighted mean ± SE (95% CI)): 3.59 ± 0.44 mg/L (2.73 – 4.45) (1 study)
All samples (weighted mean ± SE (95% CI)): 3.87 ± 0.18 mg/L (3.53 – 4.22) (5 studies)
Weighted mean analysis for alpha-tocopherol in women milk (18 studies):
Mothers of preterm infants (weighted mean ± SE (95% CI)): 6.84 ± 0.43 mg/L (5.99 – 7.69) (1 study)
Mothers of term infants (weighted mean ± SE (95% CI)): 3.45 ± 0.07 mg/L (3.31 – 3.59) (8 studies)
Colostrum (weighted mean ± SE (95% CI)): 24.11 ± 5.58 mg/L (13.17 – 35.05) (2 studies)
Transitional milk (weighted mean ± SE (95% CI)): 11.86 ± 0.56 mg/L (10.77 – 12.95) (3 studies)
Mature milk (weighted mean ± SE (95% CI)): 3.30 ± 0.07 mg/L (3.16 – 3.44) (7 studies)
Non supplemented women (either mothers of term and preterm infants) (weighted mean ± SE (95% CI)): 8.28 ± 0.32 mg/L (7.65 – 8.90) (4 studies)
Supplemented women (weighted mean ± SE (95% CI)): 3.46 ± 0.44 mg/L (2.61 – 4.32) (1 study)
All samples (weighted mean ± SE (95% CI)): 3.74 ± 0.06 mg/L (3.63 – 3.85) (18 studies)
(a)
Concentrations of individual forms alpha-, beta-, delta-, gamma-tocopherol are reported. Total vitamin E concentration in Tocopherol Equivalents (TE) is reported when
available (with definition and formulas applied). When papers reported “Vitamin E” concentration without specifying the definition or formulas, values are reported in italics.
*Method I: the rapid direct method for measuring alpha- and gamma-tocopherol in human milk using reversed-phase high performance liquid chromatography with
ultraviolet/visible (UV–vis) detection. Method II: saponification with ultraviolet/visible detection. Method III: saponification with evaporative light scattering
detection.
EFSA supporting publication 2014:EN-629
61
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Vitamin E breast milk concentration was assessed in 24 publications (23 studies) via the quantitation of alpha-tocopherol, beta-tocopherol, delta-tocopherol,
gamma-tocopherol (or sum of some of them), or total vitamin E (defined in most of cases as alpha-tocopherol + 0.25 gamma-tocopherol). Five studies were free of
confounders (Gossage, Deyhim et al. 2002; Schweigert, Bathe et al. 2004; Quiles, Ochoa et al. 2006; Orhon, Ulukol et al. 2009; Martysiak-Zurowska, SzlagatysSidorkiewicz et al. 2013). The analytical method employed was HPLC-MS/MS (23 studies). Composition data for milks of mothers who gave birth to term infants
were available for colostrum (5 studies), transitional milk (5 studies), mature milk (9 studies). Milks were collected from mothers who gave birth to term (11
studies) or preterm infants (1 study), mixed term and preterm infants (1 study), or not specified (11 studies). Vitamin E supplementation of the mothers was
mentioned in 2 studies (forms not specified, range: 0 - 30 mg/day) (Martysiak-Zurowska, Szlagatys-Sidorkiewicz et al. 2013; Vahamiko, Isolauri et al. 2013).
Maternal vitamin E intake was reported in seven studies (range from 3.43 to 16.47 mg/day) (Gossage, Deyhim et al. 2002; Olafsdottir, Wagner et al. 2001; Quiles,
Ochoa et al. 2006; Duda, Nogala-Kalucka et al. 2009; Antonakou, Chiou et al. 2011; Martysiak-Zurowska, Szlagatys-Sidorkiewicz et al. 2013; Vahamiko, Isolauri
et al. 2013); 3 studies reported data on status (as plasmatic alpha-tocopherol concentration, sum of plasmatic alpha- and gamma-tocopherols, or “total vitamin E”
concentration (with no precision on the tocopherol(s) considered)) (Thijssen, Drittij et al. 2002; Schweigert, Bathe et al. 2004; Vahamiko, Isolauri et al. 2013).
Five studies reported total vitamin E expressed as tocopherol-equivalent (TE, TE (mg) = alpha-tocopherol (mg) + 0.25 gamma-tocopherol (mg)). The weighted
mean and 95% CI for TE concentration from all samples was 3.87 (3.53 – 4.22) mg/L. Weighted means and 95% CIs for TE at different stages of lactation were as
follows: transitional milk (1 study) = 4.27 (0.01 – 8.54) mg/L; mature milk (1 study) = 3.30 (1.09 – 5.51) mg/L. When specified, milk samples were collected from
mothers who gave birth to term infants. Mothers of term infants presented TE concentration of 3.51 (1.54 – 5.47) mg/L. When women were supplemented with
“vitamin E”, weighted mean and 95% CI for TE was 3.59 (2.73 – 4.45) mg/L.
Nineteen studies reported alpha-tocopherol concentration in women milk. The weighted mean and 95% CI for alpha-tocopherol concentration from all samples was
3.74 (3.63 – 3.85) mg/L. Weighted means and 95% CIs at different stages of lactation were as follows: colostrum (2 studies) = 24.11 (13.17 – 35.05) mg/L;
transitional milk (3 studies) = 11.86 (10.77 – 12.95) mg/L; mature milk (7 studies) = 3.30 (3.16 – 3.44) mg/L. Milk samples were collected from mothers who gave
birth to both term or pre-term infants. Weighted mean and 95% CI was 6.84 (5.99 – 7.69) mg/L) for breast milk of mothers of preterm infants and 3.45 (3.31 –
3.59) mg/L for breast milk of mothers of term infants. The weighted mean and 95% CI were 8.28 (7.65 – 8.90) mg/L for milk from non-supplemented women vs.
3.46 (2.61 – 4.32) mg/L for milk from women supplemented with “vitamin E”.
Two studies showed a correlation between the concentration of vitamin E (alpha-TE as the sum of alpha- and gamma-tocopherols) in the milk and its intake (forms
not specified, range 6 – 9 mg/day) (Olafsdottir, Wagner et al. 2001; Duda, Nogala-Kalucka et al. 2009), whereas 3 other studies did not find correlation between
breast milk vitamin E concentration (alpha-TE as the sum of alpha- and gamma-tocopherols) and intake (forms not specified, 3.43 – 16.67 mg/day) (Antonakou,
Chiou et al. 2011; Martysiak-Zurowska, Szlagatys-Sidorkiewicz et al. 2013). One study failed to show correlation between maternal plasma alpha-tocopherol and
TE (alpha- + gamma-tocopherol) milk concentrations (Thijssen, Drittij et al. 2002). One study showed that plasma levels of alpha-tocopherol were significantly
lower later in lactation (day 19) than shortly after birth (P<0.01), and that levels of carotenoids, alpha-tocopherol and vitamin A were highest in colostrum and
declined (P<0.01) (Schweigert, Bathe et al. 2004).
EFSA supporting publication 2014:EN-629
62
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
4.3.3.
Choline
As described in the study flow diagram, 5 publications, from Europe (4 studies) and the US (1 study), were included from the comprehensive literature search on
choline (free and/or total choline, phosphatidylcholine, phosphocholine, glycerophosphocholine, phospholipid-bound choline) (January 2000 – January 2014).
Details are reported in the following Table 6.
Table 6:
Publication
(Holmes,
Snodgrass et al.
2000)
Summary of the included studies for choline
Population main
characteristics
British women
Supplementation
Not reported
Maternal
micronutrients intake
Not reported
Stage of lactation
Confounding
factors
Mixed: 2-6 days vs
7-22 days postpartum
Yes: The lack of
information on
specific
supplementation
and population
Analytical
method
“Choline”
concentration in
breast milk (a)
Proton nuclear
magnetic
resonance
spectroscopy
Colostrum/
Transitional milk (2-6
days) (mean ± SD):
Free choline : 11.46 ±
2.08 mg/L
Number of
women
(number of
samples)
8 (8)
Total choline (sum of
free choline,
phosphocholine,
glycerolphosphocholine,
phosphatidylcholine,
sphingomyelin): 62.50
± 9.38 mg/L
Transitional/Mature
milk (7-22 days)
(mean ± SD):
Free choline (7-22
days): 21.88 ± 5.21
mg/L
Total choline (sum of
EFSA supporting publication 2014:EN-629
63
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Publication
Population main
characteristics
Supplementation
Maternal
micronutrients intake
Stage of lactation
Confounding
factors
Analytical
method
“Choline”
concentration in
breast milk (a)
Number of
women
(number of
samples)
free choline,
phosphocholine,
glycerolphosphocholine,
phosphatidylcholine,
sphingomyelin):
133.34 ± 14.58 mg/L
(Ilcol, Ozbek et
al. 2005)
Turkish women
Not reported
Not reported
Colostrum: 0-2
days
Yes: lack of
information on
specific
supplementation
and population
Modification
of the
enzymatic
radiochemical
method
Colostrum (mean ±
SEM):
total choline (sum of
free choline,
phosphocholine,
glycerolphosphocholine,
phosphatidylcholine,
sphingomyelin): 70.42
± 3.65 mg/L
Colostrum
group: Not
reported (21)
free choline: 13.75 ±
2.19 mg/L
Mature milk: 12-28
days
EFSA supporting publication 2014:EN-629
Mature milk (12-28
days) (mean ± SEM):
total choline (sum of
free choline,
phosphocholine,
glycerolphosphocholine,
phosphatidylcholine,
sphingomyelin):
166.15 ± 8.54 mg/L
Mature milk
group (12-28
days): Not
reported (14)
64
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Publication
Population main
characteristics
Supplementation
Maternal
micronutrients intake
Stage of lactation
Confounding
factors
Analytical
method
“Choline”
concentration in
breast milk (a)
Number of
women
(number of
samples)
free choline: 31.15 ±
3.75 mg/L
Mature milk: 75-90
days
Mature milk (75-90
days) (mean ± SEM):
total choline (sum of
free choline,
phosphocholine,
glycerolphosphocholine,
phosphatidylcholine,
sphingomyelin):
150.11 ± 8.75 mg/L
Mature milk
group (75-90
days): Not
reported (12)
free choline: 29.79 ±
2.19 mg/L
Mature milk: 165180 days
Mature milk group
(165-180 days) (mean
± SEM):
total choline (sum of
free choline,
phosphocholine,
glycerolphosphocholine,
phosphatidylcholine,
sphingomyelin): :
140.53 ± 10.94 mg/L
Mature milk
group (165180 days):
Not reported
(11)
free choline: 13.75 ±
1.56 mg/L
Mature milk: 12EFSA supporting publication 2014:EN-629
Mature milk group
Mature milk
65
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Publication
Population main
characteristics
Supplementation
Maternal
micronutrients intake
Stage of lactation
Confounding
factors
Analytical
method
180 days
“Choline”
concentration in
breast milk (a)
Number of
women
(number of
samples)
(12-180 days) (mean ±
SEM):
total choline (sum of
free choline,
phosphocholine,
glycerolphosphocholine,
phosphatidylcholine,
sphingomyelin):
153.76 ± 5.00 mg/L
group (12-180
days): Not
reported (95)
free choline: 23.75 ±
1.04 mg/L
(Fischer, Da
Costa et al. 2010)
American (89%),
African-American
(3%), Asian (6%),
American Indian
(1%), other (1%)
Yes: Supplemented
group with 750 mg
choline/day
No: Placebo group
Supplemented group:
Dietary choline (mean ±
SE (range)) 338 ± 14
(124 - 622 ) mg/day;
Total choline for diet and
supplement (mean ± SE):
1088 ± 14 mg/day
Placebo group: Dietary
choline (mean ± SE
(range)): 364 ± 18 (139 671) mg/day
Mature milk: 45
days
No
Liquid
chromatograp
hy/mass
spectrometry
Supplemented group
(mean ± SE):
Supplemente
d group: 51
(51)
free choline: 11.04 ±
1.04 mg/L
phosphatidylcholine:
11.77 ± 0.52 mg/L
Placebo group (mean
± SE):
Placebo
group: 48 (48)
free choline: 8.65 ±
0.83 mg/L
phosphatidylcholine:
11.15 ± 0.73 mg/L
EFSA supporting publication 2014:EN-629
66
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Publication
(Ozarda, Cansev
et al. 2014)
Population main
characteristics
Turkish women
Supplementation
Not reported
Maternal
micronutrients intake
Not reported
Stage of lactation
Colostrum: 3 days
Transitional milk:
6-14 days
Confounding
factors
Analytical
method
Yes: Few
information on
population and
lack of
information on
specific
supplementation
Not reported
“Choline”
concentration in
breast milk (a)
Colostrum group
(median, as
determined
graphically):
Free choline: 50 mg/L
Number of
women
(number of
samples)
Colostrum
group: 67 (67)
Total choline (no
details on the forms
taken into account):
425 mg/L
As values were
very high
compared to the
other papers, we
did not include
them in the
weighted mean
analyses
Transitional milk
group (median, as
determined
graphically):
Free choline: 120 mg/L
Transitional
milk group: 47
(47)
Total choline (no
details on the forms
taken into account): 2
250 mg/L
Mature milk: 28178 days
Mature milk group
(median, as
determined
graphically):
Free choline: 100 mg/L
Mature milk
group: 71 (71)
Total choline(no details
on the forms taken into
account): 2 050 mg/L
Ozarda, Cansev et
Turkish women
No
EFSA supporting publication 2014:EN-629
Not reported
Colostrum: 1-3
No
HPLC for free
Median (1st-3rd
67
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Publication
al. 2014
Population main
characteristics
Supplementation
mothers of term
infants
Maternal
micronutrients intake
Stage of lactation
days
Confounding
factors
Analytical
method
“Choline”
concentration in
breast milk (a)
choline,
phosphorcholine,
glycerolphosphocholine and
total choline
quartiles)
Enzymatic
colorimetric
method for
phospholipidbound choline
Glycerophosphocholine: 24.69
(10.29 – 50.67) mg/L
Number of
women
(number of
samples)
Free choline: 7.40
(2.19 – 13.65) mg/L
Phosphocholine: 7.00
(2.39 – 20.62) mg/L
Phospholipid-bound
choline: 20.21 (18.44 –
22.61) mg/L
Total choline: 42.40
(31.36 – 72.09) mg/L
Mature milk: 22180 days
Median (1st-3rd
quartiles)
Free choline: 9.69
(6.98 – 13.85) mg/L
Phosphocholine: 64.64
(48.06 – 96.49) mg/L
Glycerophosphocholine:
246,42 (194.46 –
293.49) mg/L
EFSA supporting publication 2014:EN-629
68
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Publication
Population main
characteristics
Supplementation
Maternal
micronutrients intake
Stage of lactation
Confounding
factors
Analytical
method
“Choline”
concentration in
breast milk (a)
Number of
women
(number of
samples)
Phospholipid-bound
choline: 19.38 (17.60 –
22.92) mg/L
Total choline: 159.59
(130.21 – 176.57)
mg/L
Weighted mean analysis for choline total/free concentration in women milk (4 studies):
Supplemented women (weighted mean ± SE (95% CI)): NA*/11.63 ± 0.47 mg/L (10.71 – 12.54) (1 study)
Non supplemented women (weighted mean ± SE (95% CI)): 56.90 ± 8.99 mg/L (39.29 – 74.51)/10.01 ± 0.53 mg/L (8.97 – 11.05) (2 studies)
Mothers of term infants (weighted mean ± SE (95% CI)): 56.90 ± 8.99 mg/L (39.29 – 74.51)/8.97 ± 1.95 mg/L (5.14 – 12.79) (1 study)
Colostrum (weighted mean ± SE (95% CI)): 42.40 ± 9.60 mg/L (23.58 – 61.22)/7.40 ± 3.47 mg/L (0.59 – 14.21) (1 study)
Mature milk (weighted mean ± SE (95% CI)): 159.59 ± 25.55 mg/L (109.52 – 209.66)/9.69 ± 2.36 mg/L (5.07 – 14.31) (1 study)
All samples (weighted mean ± SE (95% CI)): 105.71 ± 2.36 mg/L (101.08 – 110.35)/12.82 ± 0.31 mg/L (12.21 – 13.44) (4 studies)
(a)
Total and free choline concentrations are reported. When available, phosphatidylcholine concentration is also reported.
*NA: not applicable, total choline was not measured.
Five studies deal with choline breast milk concentration (free and/or total choline, phosphatidylcholine, phosphocholine, glycerophosphocholine, phospholipidbound choline). Two studies were free of confounders (Fischer, Da Costa et al. 2010; Ozarda, Cansev et al. 2014). Free choline (5 studies), total choline (4 studies),
phosphatidylcholine (1 study), phosphocholine (1 study), glycerophosphocholine (1 study) and phospholipid-bound choline (1 study) were measured via HPLCMS/MS (2 studies), enzymatic method (2 studies) or proton nuclear magnetic resonance spectroscopy (1 study). One study (Ozarda, Cansev et al. 2014) did not
report the analytical method for choline analysis. Composition data were available for colostrum (1 study) and mature milk (1 study). The gestational age of the
EFSA supporting publication 2014:EN-629
69
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
infants (term/preterm) was specified only in one study where mothers of term infants were involved. One study reported data on choline intake from diet and
supplementation (mean dietary intake was 351 mg/day and mean total intake for supplemented women was 1088) (Fischer, Da Costa et al. 2010).
The weighted mean and 95% CI from all samples was 12.82 (12.21 – 13.44) mg/L for free choline and 105.71 (101.08 – 110.35) mg/L for total choline
concentrations, respectively. Weighted means and 95% CIs at different stages of lactation were as follows (free choline/total choline): colostrum = 7.40 (0.59 –
14.21)/ 42.40 (23.58 – 61.22) mg/L; mature milk = 9.69 (5.07 – 14.31)/159.59 (109.52 – 209.66) mg/L. When specified, milk samples were collected from mothers
who gave birth to term infants (weighted mean and 95% CI for free choline/total choline: 8.97 (5.14 – 12.79)/56.90 (39.29 – 74.51) mg/L). Free choline breast milk
concentration was (weighted mean and 95% CI): 11.63 (10.71 – 12.54) mg/L in women supplemented with choline and (weighted mean and 95% CI): 10.01 (8.97 –
11.05) mg/L in women non-supplemented. Total choline concentration was only reported for non-supplemented women (weighted mean and 95% CI): 56.90 (39.29
– 74.51) mg/L.
Two studies investigated choline status (defined by free choline plasma concentration) and found a correlation between choline status and breast milk free choline
concentration (Ilcol, Ozbek et al. 2005; Fischer, Da Costa et al. 2010). Breast milk concentrations of choline, phosphatidylcholine and phosphocholine were
significantly correlated with total choline intake (1088 mg/day) in one study (Fischer, Da Costa et al. 2010).
One study investigated changes with time according to breast milk “choline” concentration (Ilcol, Ozbek et al. 2005). They showed that, in mature milk, free
choline, phosphocholine and glycerophosphocholine concentrations were significantly higher than the observed concentrations in colostrum, but that total
phospholipid-bound choline, phosphatidylcholine and sphingomyelin contents of mature milk and colostrum were similar. Then, free choline contents in mature
breast milk decreased with time with a significant inverse relationship between free choline concentrations in breast milk and lactating days; on the contrary, there
were no significant relationships between the lactation days and total choline, phosphocholine, glycerophosphocholine, phosphatidylcholine or sphingomyelin
contents of breast milk.
EFSA supporting publication 2014:EN-629
70
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
4.3.4.
Phosphorus
As described in the study flow diagram, 5 publications were included from the comprehensive literature search on phosphorus (January 2000 – January 2014).
Details are reported in the following Table 7.
Table 7:
Publication
Summary of the included studies for phosphorus
Population main
characteristics
Supplementation
Maternal
micronutrients intake
Stage of lactation
Confounding
factors
Analytical
method
Phosphorus
concentration in
breast milk
Number of
women
(number of
samples)
(SanchezHidalgo, FloresHuerta et al.
2000)
Mexican women
Not reported
Not reported
Not reported
Yes: lack of
information on
specific
supplementation
and population
Not reported
Phosphorus: 140 mg/L
Not reported
(Gulson, Mizon et
al. 2001)
6 Australians and
31 migrants
Not reported
Phosphorus daily intake
(mean): 606 mg
(nonpregnant migrants),
788 mg (pregnant
migrants), 940 mg
(Australian pregnant
subjects).
Not reported
Yes: No
information on
supplementation
Not reported
Mean ± SD (median):
17 (78)
No
Not reported
Phosphorus:117.8 ±
16.94 (120) mg/L
Potassium daily intake
(mean): 1392 mg
(nonpregnant migrants),
1710 mg (pregnant
migrants), 1938 mg
(Australian pregnant
subjects)
(Nickkho-Amiry,
Prentice et al.
Arab women (14)
No vitamin D
supplements
EFSA supporting publication 2014:EN-629
Dietary phosphorus
intake (median (range)):
745 (179 - 915) mg/day
Mature milk: 9-13
weeks
Phosphorus (median
(range)): 124.62 (74.40
Arab women:
14 (14)
71
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Publication
Population main
characteristics
Supplementation
Maternal
micronutrients intake
Stage of lactation
Confounding
factors
Analytical
method
Phosphorus
concentration in
breast milk
Number of
women
(number of
samples)
– 186.93) mg/L
2008)
White Caucasian
women (10) from
United Kingdom
(Witczak and
Jarnuszewska
2011)
Polish women
(Bjorklund,
Vahter et al.
2012)
Swedish women
Dietary phosphorus
intake (median (range)):
841 (764 - 987) mg/day
Not reported
Not reported
Not reported
Not reported
Mature milk: 5-6
months
Mature milk: 14-21
days
Yes: lack of
information on
specific
supplementation
and population
ICP-AES
Yes: No
information on
supplementation
ICP-MS
Phosphorus (median
(range)): 123.69 (76.88
– 159.65) mg/L
White
Caucasian
women: 10
(10)
Mean:
Not reported
(9)
Phosphorus:13
mg/100g (conversion
undoable, data was not
included in the
analyses)
Phosphorus (mean ±
SD): 172 ± 23 mg/L
60 (840)
Weighted mean analysis for phosphorus concentration in women milk:
All samples (weighted mean ± SE (95% CI)): 131.71 ± 7.12 mg/L (117.75 – 145.67) (4 studies)
Five studies reported phosphorus breast milk concentration. One study was free of confounders (Nickkho-Amiry, Prentice et al. 2008). Phosphorus concentration
was quantified via the ICP-MS analytical method (2 studies). Three studies did not report the analytical method for phosphorus dosage. Three studies were
performed on mature milk samples and 2 other studies did not precise the stage of lactation. The involvement of mothers of term or preterm infants was not
specified. Two studies reported on phosphorus intakes (range: 179 – 987 mg/day) (Gulson, Mizon et al. 2001; Nickkho-Amiry, Prentice et al. 2008). Phosphorus
status, as defined by phosphorus plasma concentration, was reported in one study (Nickkho-Amiry, Prentice et al. 2008).
The weighted mean and 95 % CI phosphorus concentration from all samples was 131.71 (117.75 – 145.67) mg/L.
There was no information from available studies on the relationship between phosphorus intake (including supplementation) or status and breast milk
concentration.
EFSA supporting publication 2014:EN-629
72
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
4.3.5.
Potassium
As described in the study flow diagram, 3 publications were included from the comprehensive literature search on potassium (October 2010 – January 2014).
Details are reported in the following Table 8.
Table 8:
Publication
Summary of the included studies for potassium
Population main
characteristics
(Witczak and
Jarnuszewska
2011)
Polish women
(Bauer and Gerss
2011)
German mothers of
pre-term infants
German mothers of
term infants
Supplementation
Not reported
Not reported
Not reported
EFSA supporting publication 2014:EN-629
Maternal
micronutrients intake
Not reported
Not reported
Not reported
Stage of lactation
Mature milk: 5-6
months
Mixed (1-8 weeks)
Mixed (1-8 weeks)
Confounding
factors
Analytical
method
Potassium
concentration in
breast milk
Yes: lack of
information on
specific
supplementation
and population
ICP-AES
Mean:
Yes: No
information on
supplementation
Absorption
spectrometer
and
colorimetric
assay with
endpoint
determination
Mean ± SD:
Yes: No
information on
supplementation
Absorption
spectrometer
and
colorimetric
Mean ± SD:
Number of
women
(number of
samples)
Not reported
(9)
Potassium:52 mg/100g
(conversion undoable,
these results were not
included in the
analyses)
Potassium:
Preterm group (<28
weeks) 547.38 ± 86.02
mg/L;
Preterm group (28-31
weeks) 512.19 ± 97.75
mg/L;
Preterm group (32-33
weeks) 473.09 ± 70.38
mg/L
Potassium: 449.63 ±
Total number
of subjects:
102 (no data)
Total number
of subjects:
102 (no data)
73
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Publication
(Bjorklund,
Vahter et al.
2012)
Population main
characteristics
Swedish women
Supplementation
Not reported
Maternal
micronutrients intake
Not reported
Stage of lactation
Mature milk: 14-21
days
Confounding
factors
Yes: No
information on
supplementation
Analytical
method
Potassium
concentration in
breast milk
assay with
endpoint
determination
74.29 mg/L
ICP-MS
Potassium (mean ±
SD): 633 ± 4 mg/L
Number of
women
(number of
samples)
60 (840)
Weighted mean analysis for potassium concentration in women milk (2 studies):
Mothers of preterm infants (weighted mean ± SE (95% CI)): 505.09 ± 47.58 mg/L (411.82 – 598.35) (1 study)
Mothers of term infants (weighted mean ± SE (95% CI)): 449.63 ± 74.29 mg/L (304.02 – 595.24) (1 study)
All samples (weighted mean ± SE (95% CI)): 561.10 ± 28.31 mg/L (505.62 – 616.58) (2 studies)
Three studies reported potassium breast milk concentration. No study was free of confounders. Potassium concentration was quantified via the ICP-MS analytical
method (3 studies). Analyses were performed on mature milk samples (2 studies) or mixed milk samples (transitional/mature milk, 1 study. When reported, milks
were collected from mothers who gave birth to both term and preterm infants (1 study). None of the studies reported intake and/or status data.
The weighted mean and 95% CI potassium concentration from all samples was 561.10 (505.62 – 616.58) mg/L. Mothers of preterm infants presented potassium
breast milk concentration of (weighted mean and 95% CI): 505.09 (411.82 – 598.35) mg/L, mothers of term infants presented potassium breast milk concentration
of (weighted mean and 95% CI): 449.63 (304.02 – 595.24) mg/L.
There was no information from these studies on the relationship between potassium intake (including supplementation) or status and breast milk concentration.
EFSA supporting publication 2014:EN-629
74
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
4.4.
Vitamin A, Vitamin B1, chloride, copper, magnesium, sodium
4.4.1.
Vitamin A
As described in the study flow diagram, 19 publications (18 studies) were recorded from the comprehensive literature search on vitamin A (January 2000 – January
2014). Details are reported in the following Table 9.
Table 9:
Summary of the included studies for vitamin A
Publication
Population main
characteristics
Sanchez-Hidalgo,
Flores-Huerta et
al. 2000
Mexican
women
mothers of preterm
infants
Not reported
Not reported
Olafsdottir,
Wagner et
2001
Icelandic women
Yes: cod liver oil
(no
other
supplements);
Cod liver oil
Daily intakes: vit
± 1.5 mg/day, vit
specified): 3653
mg/day
al.
Supplementation
No: no cod liver oil
group
Maternal
micronutrients intake
group:
E: 9.0
A (not
± 645
No cod liver oil group:
Daily intake: vit E: 6.0 ±
0.5 mg/day, vit A (not
specified): 1165 ± 124
mg/day
EFSA supporting publication 2014:EN-629
Stage of lactation
Confounding
factors
Analytical
method
“Vitamin A”
concentration in
breast milk (a)
Number of
women
(number of
samples)
Not reported
Yes:
no
information
on
type of milk nor
on women details;
besides, there is a
strong suspicion
of a mistake in the
article for the
recording of the
value
(this
measure has been
excluded from the
calculations)
Not reported
“Vitamin A” (not
specified): 223 IU/dl
Not reported
Mature milk: 2-4
months
Yes:
lack
of
information
on
supplementation
of the nutrients of
interest (In the
article
are
described
only
data about cod
liver
oil
supplementation)
HPLC
Mean ± SE:
18 (18)
Vitamin A (retinol
equivalents
RE
calculated as follows:
RE (µg) = all-trans
retinol (µg) + 0.546
retinylpalmitate (µg)
+ 1/6 ß-carotene +
1/12 α-carotene + 1/12
cryptoxanthin): 618 ±
59 (59)
The results for
all
subjects
(77(77
samples)) are
also presented.
75
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Publication
Population main
characteristics
Supplementation
Maternal
micronutrients intake
Stage of lactation
Confounding
factors
Analytical
method
“Vitamin A”
concentration in
breast milk (a)
Number of
women
(number of
samples)
35 µg/L
Vitamin
A
(alltransretinol): 87 ± 12
µg/L
Vitamin
A
(retinylpalmitate):
965 ± 55 µg/L
Median (range):
Vitamin A (RE): 584
(177-1 889) µg/L
Vitamin
A
(alltransretinol): 55 (17651) µg/L
Vitamin
A
(retinylpalmitate):
868 (264-2 876) µg/L
Gossage, Deyhim
et
al.
2002;
Gossage, Deyhim
et al. 2000
European American
(n=17),
Hispanic
(n=2),
African
American (n=2)
Yes: Beta-carotene
group:
betacarotene
30
mg/day;
No: Placebo group
Beta-carotene group:
dietary intakes (mean ±
SD): vit A: 2149 ± 1141
µg RE (formula not
reported); vit E: 7.0 ± 4.5
mg; total carotenoids:
12060 ± 2934 µg; betacarotene: 4942 ± 2429
µg; alpha-carotene: 844
± 683 µg
Colostrum: 4 days
Mature
days
milk:
32
No but strong
suspicion of error
according to units,
not included in
the calculations.
HPLC
Mean ± SD (data for all
subjects): Vitamin A
(retinol): 1 416 208.8
± 154 396.6 µg/L
Beta-carotene
group: 10 (80)
Placebo
group: 9 (72)
Mean ± SD (data for all
subjects): Vitamin A
(retinol): 595 529.6 ±
595 529.6 µg/L
Placebo group: dietary
intakes (mean ± SD): vit
A: 2378 ± 1008 µg RE;
EFSA supporting publication 2014:EN-629
76
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Publication
Population main
characteristics
Supplementation
Maternal
micronutrients intake
Stage of lactation
Confounding
factors
Analytical
method
“Vitamin A”
concentration in
breast milk (a)
Number of
women
(number of
samples)
vit E: 7.0 ± 3.8 mg; total
carotenoids: 16733 ±
12586
µg;
betacarotene: 6490 ± 4455
µg;
alpha-carotene:
1491 ± 1186 µg
Canfield,
Clandinin et al.
2003
Australian women,
Canadian women,
Mexican women,
British
women,
American women
mothers of term
infants
No: Mothers who
were
taking
vitamins or other
supplements
containing
carotenoids
or
vitamin A > 8000
IU/day
were
excluded.
Not reported
Mature milk (1-12
months)
No
HPLC
Mean ± SE (Australia,
Canda, Mexico, United
Kingdom, United
States):
Alpha-carotene:
18.25 ± 1.61 µg/L
19.33 ± 1.61 µg/L
16.64 ± 1.07 µg/L
16.64 ± 1.61 µg/L
8.59 ± 1.07 µg/L
48 (48)
53 (53)
47 (47)
49 (49)
41 (41)
Beta-carotene:
32.21 ± 3.76 µg/L
19.33 ± 1.61 µg/L
27.38 ± 2.68 µg/L
25.77 ± 1.61 µg/L
19.86 ± 2.15 µg/L
53 (53)
55 (55)
50 (50)
49 (49)
49 (49)
Retinol:
311.09 ± 15.75 µg/L
340.30 ± 18.91 µg/L
378.40 ± 24.92 µg/L
301.46 ± 14.32 µg/L
EFSA supporting publication 2014:EN-629
53 (53)
55 (55)
50 (50)
50 (50)
77
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Publication
Population main
characteristics
Supplementation
Jewell, Mayes et
al. 2004
Irish
women
mothers of both
term and preterm
infants
Not reported
Schweigert, Bathe
et al. 2004
German
mothers
infants
No
supplements
containing
carotenoids
or
vitamin A
of
women
term
Maternal
micronutrients intake
Not reported
Not reported
Stage of lactation
Mixed: 1-41 days
Colostrum: 4 ± 2
days
Confounding
factors
Analytical
method
“Vitamin A”
concentration in
breast milk (a)
Number of
women
(number of
samples)
351.74 ± 24.92 µg/L
49 (49)
13 (28)
Yes:
Few
information
on
population
and
lack
of
information
on
specific
supplementation
Modified
version of the
step gradientHPLC
methods
Median (range):
No
HPLC
Vitamin A (retinol)
(colostrum) (mean ±
SD): 1 532.51 ± 724.72
µg/L
Vitamin A (retinol):
1.49 (0.28 – 7.96)
µmol/g of fat
Vitamin A (alphacarotene): 12.77 (0.063.14) nmol/g of fat
Vitamin A (betacarotene): 1.7 (0.05.07) nmol/g of fat
21 (21)
Alpha-carotene
(colostrum) (mean ±
SD): 91.48 ± 79.19
µg/L
Beta-carotene
(colostrum) (mean ±
SD): 227.31 ± 175.34
µg/L
Mature milk: 19±2
days
Vitamin A (retinol)
(mature milk) (mean ±
SD): 830.71 ± 320.82
µg/L
Alpha-carotene
(mature milk) (mean ±
EFSA supporting publication 2014:EN-629
78
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Publication
Population main
characteristics
Supplementation
Maternal
micronutrients intake
Stage of lactation
Confounding
factors
Analytical
method
“Vitamin A”
concentration in
breast milk (a)
Number of
women
(number of
samples)
SD): 11.38 ± 7.68 µg/L
Beta-carotene (mature
milk) (mean ± SD):
41.98 ± 24.80 µg/L
Schulz, Engel et
al. 2007
Aurvag,
Henriksen et al.
2007
German
mothers
infants
of
women
term
Norwegian women
mothers of preterm
infants
Tokusoglu,
Tansug et al. 2008
Turkish
mothers
infants
Tijerina-Saenz,
Innis et al. 2009
Canadian women
(Caucasian
73%)
mothers of term
of
women
term
No
Exclusion criteria:
intake beta-carotene
(2gm/d) or vitamin
A (>2000 IU/d)
Retinol intake (mean ±
SD): 0.95 ± 0.64 mg/d;
Total
vit
A
(not
specified, mean ± SD):
2.11 ± 0.89 mg/d
Colostrum (2 days)
Yes: Multivitamins
with 750 µg retinol
equivalents/day
regardless of infant
weight
for
the
reference protocol;
human
milk
fortifier
corresponding
to
513 to 1026 µg
retinol
equivalents/day
according to infant
weight
Not reported
Infants in the modified
group
received
significantly
more
vitamin A than infants in
the reference
group
during three out of the
four
periods.
The
difference in vitamin A
intake was greatest in the
last period (gestational
age > 37 weeks): 578
versus 316 g/kg/day (p =
0.02).
Mixed
Not reported
Mature milk: 60-90
days
Yes: The lack of
information
on
specific
supplementation
HPLC
Vitamin A (retinol)
(mean ± SD): 815 ±
120.6 µg/L
92 (92)
Yes: All women
reported
taking
multivitamin
Not reported
Mature
month
No
HPLC
Mean ± SE (range):
Vitamin A (all-transretinol): 80 ± 10 (10-
60 (60)
EFSA supporting publication 2014:EN-629
No
HPLC
Mean ± SD:
Retinol: 1105.70
850.76 µg/L
±
Retinol:
27
(27)
Beta-carotene:
26 (26)
Beta-carotene: 365.07
± 327.49 µg/L
No
HPLC
“Vitamin
(unspecified)
However, due to
the uncertainty of
the value for
vitamin
A
concentration, it
was not included
in the weighted
mean analyses.
milk:
1
Mean:
A”
Mixed
milks
from
reference and modified
protocols: 540 µg/L
Reference
protocol: 23
(31 – total
number
of
samples);
Modified
protocol: 30
(31 – total
number
of
samples)
79
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Publication
Population main
characteristics
infants
Tacken,
Vogelsang et al.
2009
Women
Netherlands
mothers of
infants
Supplementation
Maternal
micronutrients intake
Stage of lactation
Confounding
factors
Analytical
method
supplements
in
term
Yes: 6 women used
multivitamin
supplements
containing 1440 µg
β-carotene per day
“Vitamin A”
concentration in
breast milk (a)
Number of
women
(number of
samples)
200) µg/L
Not reported
Mature milk (mean
± SD: 4.2 ± 1.2
months)
No
HPLC
Median
quartile):
(1st,
3rd
Beta-carotene:
(0-8.59) µg/L
5.37
30 (30)
Alpha-carotene: 15.57
(11.81-25.77) µg/L
Duda,
NogalaKalucka et al.
2009
Polish women
Not reported
The mean intake of
vitamin E was 7.7 ± 3.4
mg/day.
The mean vitamin A
equivalent concentration
(formula not given) in
daily food rations (DFR)
was 1012 ± 735 μg/day.
Orhon, Ulukol et
al. 2009
Non-smoker
Turkish women
mothers of term
infants
No
Total “vitamin A +
retinol” (mean (SEM)):
4965.2 (538.5) IU/day
Mature milk (~96%
of the inquired
women were breast
feeding for 2.5
month
on
the
average-this period
ranged from 1-12
months)
Yes: The lack of
information
on
specific
supplementation
HPLC
Mean ± SD: vitamin A
(all-trans
retinol):
570.70 ± 500.30 µg/L;
Median
(range)
vitamin A (all-trans
retinol): 293.8 µg/L
(157.2-1424.1 µg/L)
30 (30)
Transitional milk (7
days)
No
HPLC
β –carotene (mean ±
SEM): 536.9 ± 80.6
µg/L
20 (20)
Retinol (mean ± SEM):
2 463.5 ± 200.5 µg/L
Smoker Turkish
women mothers of
term infants
No
Total vitamin A + retinol
(mean (SEM)): 4669.0
(358.3) IU/day
Transitional milk (7
days)
No
HPLC
β –carotene (mean ±
SEM): 483.2 ± 64.4
µg/L
20 (20)
Retinol (mean ± SEM):
2 320.3 ± 171.9 µg/L
Schweigert, Raila
German women
Not reported
EFSA supporting publication 2014:EN-629
Not reported
Not reported
Yes:
No
HPLC
Vitamin
A
No data (25)
80
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Publication
Population main
characteristics
Supplementation
Maternal
micronutrients intake
Stage of lactation
et al. 2011
Confounding
factors
Analytical
method
information
on
supplementation
and population
“Vitamin A”
concentration in
breast milk (a)
Number of
women
(number of
samples)
(unspecified) (Mean ±
SD):
Standard procedure of
the extraction (A): 493
± 327 µg/L
Due
to
the
uncertainty of the
value for vitamin
A concentration,
it
was
not
included in the
weighted
mean
analyses
Vitamin
A
(unspecified) (Mean ±
SD):
Ready-to-use
extraction (B): 507 ±
367 µg/L
Vitamin
A
(unspecified) (Mean ±
SD):
Disposable
vial
measured
in
the
portable
fluorophometer, iCheck
(C): 493 ± 332 µg/L
Kasparova, Plisek
et al. 2012
Czech
mothers
women
Not reported
EFSA supporting publication 2014:EN-629
Not reported
Mature milk: 1-2
months
Yes:
No
information
on
supplementation
HPLC
Vitamin A (retinol)
(mean ± SD):
12 (12)
Mature
milk
(1-2
months) group: 458.32
± 286.45 µg/L
Mature milk: 3-4
months
Mature
milk
(3-4
months) group: 315.10
± 257.81 µg/L
Mature milk: 5-6
Mature
milk
(5-6
months) group: 229.16
81
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Publication
Population main
characteristics
SzlagatysSiodorkiewicz,
Zagierski et al.
2012
Vähämiko,
Isolauri et
2013
al.
Polish
mothers
infants
women
of term
Finnish
women
(Caucasian)
Supplementation
Maternal
micronutrients intake
Yes:
Among
63.18% and 52%
women
it
was
recorded use of
vitamin
supplementation,
whose milk samples
were examined on
the 3rd and 30th32nd days after
delivery.
Not reported
Yes: Vit. A (retinol)
from supplements mean (95% CI):
35.6 (5.46 - 65.74)
µg
Vit. A (RE, formula not
specified) from diet mean (95% CI): 1164
(985-1 344) RE
Stage of lactation
EFSA supporting publication 2014:EN-629
A
(retinol)
Vit. A (RE, formula not
Analytical
method
“Vitamin A”
concentration in
breast milk (a)
Number of
women
(number of
samples)
months
± 114.58 µg/L
Mature milk: 9-12
months
Mature milk (9-12
months) group: 171.87
± 114.58 µg/L
Colostrum: 3rd day
No
Transitional milk:
30th-32nd day
However, due to
the uncertainty of
the value for
vitamin
A
concentration, it
was not included
in the weighted
mean analyses.
Colostrum
Mature
month
Vit.
Confounding
factors
milk:
Colostrum
Population
allergy
(fever,
asthma,
atopic
eczema or food
allergy) in the
family (mother,
father or sibling
of unborn child).
1
Due
to
the
uncertainty of the
value for vitamin
A concentration,
it
was
not
included in the
weighted
mean
analyses.
HPLC
Median
(1st,
3rd
quartile): Vitamin A
(unspecified): 126.15
(79.12-158.63) µg/L
49 (49)
Median
(1st,
3rd
quartile): Vitamin A
(unspecified):
84.7
(51.45-134.68) µg/L
HPLC
Mean (95% CI):
Vitamin
A
(unspecified)
(Intervention group with individual dietary
counselling): 1372.10
(1214.55-1552.56)
µg/L
Intervention
group - with
individual
dietary
counseling: 44
(44);
Control group:
45 (45)
Vitamin
A
(unspecified)
(Intervention group with individual dietary
counselling):
492.69
(429.68-564.31) µg/L
Vitamin
A
82
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Publication
Song, Jouni et al.
2013
Population main
characteristics
American women
mothers of term
infants
Supplementation
Maternal
micronutrients intake
from supplements mean (95% CI):
42.01 (11.5-72.52)
µg
specified) from diet mean (95% CI): 969
(792-1147) RE
Not reported
Not reported
Stage of lactation
Confounding
factors
Analytical
method
“Vitamin A”
concentration in
breast milk (a)
Number of
women
(number of
samples)
(unspecified) (Control
group):
1051.27
(859.35-1283.30) µg/L
Mature
month
milk:
1
Transitional milk (1
week)
Vitamin
A
(unspecified) (Control
group):
466.91
(409.60-529.93) µg/L
Yes:
No
information
on
supplementation
Liquid
chromatograp
hy-diode array
detector
Mean ± SE (range):
Alpha-carotene: 31.68
± 7.25 (6.44-118.43)
µg/L;
Beta-carotene: 88.21 ±
13.53
(9.29-175.99)
µg/L
Mature
weeks)
milk
(4
16
14
15
17
16
16 (16)
(16)
(14)
(15)
(17)
(16)
Alpha-carotene: 10.31
± 1.61 (3.92-24.96)
µg/L;
Beta-carotene: 56.05 ±
14.87
(5.74-202.61)
µg/L
Mature
weeks)
milk
(13
Alpha-carotene: 12.46
± 2.58 (1.99-43.06)
µg/L;
Beta-carotene: 47.24 ±
12.51
(4.56-189.30)
µg/L
EFSA supporting publication 2014:EN-629
83
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Publication
Population main
characteristics
Supplementation
Maternal
micronutrients intake
Stage of lactation
Confounding
factors
Analytical
method
“Vitamin A”
concentration in
breast milk (a)
Number of
women
(number of
samples)
Weighted mean analysis for retinol concentration in women milk (8 studies):
Mothers of term infants (weighted mean ± SE (95% CI)): 233.74 ± 6.32 µg/L (221.36 – 246.12) (6 studies)
Colostrum (weighted mean ± SE (95% CI)): 1 353.03 ± 551.69 µg/L (271.72 – 2434.34) (2 studies)
Transitional milk (weighted mean ± SE (95% CI)): 2 380.97 ± 130.50 µg/L (2 125.18 – 2 636.75) (1 study)
Mature milk (weighted mean ± SE (95% CI)): 228.55 ± 6.32 µg/L (216.15 – 240.94) (4 studies)
Non supplemented women (weighted mean ± SE (95% CI)): 333.13 ± 8.17 µg/L (317.12 – 349.15) (3 studies)
All samples (weighted mean ± SE (95% CI)): 206.06 ± 5.57 µg/L (195.14 – 216.97)
Weighted mean analysis for alpha-carotene concentration in women milk (4 studies):
Mothers of term infants (weighted mean ± SE (95% CI)): 14.30 ± 0.53 µg/L (13.26 – 15.34) (4 studies)
Colostrum (weighted mean ± SE (95% CI)): 91.48 ± 79.19 µg/L (13.73 – 246.69) (1 study)
Transitional milk (weighted mean ± SE (95% CI)): 31.68 ± 7.25 µg/L (17.47 – 45.88) (1 study)
Mature milk (weighted mean ± SE (95% CI)): 14.20 ± 0.53 µg/L (13.16 – 15.25) (4 studies)
Non supplemented women (weighted mean ± SE (95% CI)): 14.80 ± 0.59 µg/L (13.65 – 15.95) (1 study)
Supplemented women (weighted mean ± SE (95% CI)): 15.57 ± 3.89 µg/L (7.94 – 23.20) (1 study)
All samples (weighted mean ± SE (95% CI)): 14.30 ± 0.53 µg/L (13.26 – 15.34)
EFSA supporting publication 2014:EN-629
84
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Publication
Population main
characteristics
Supplementation
Maternal
micronutrients intake
Stage of lactation
Confounding
factors
Analytical
method
“Vitamin A”
concentration in
breast milk (a)
Number of
women
(number of
samples)
Weighted mean analysis for beta-carotene concentration in women milk (6 studies):
Mothers of term infants (weighted mean ± SE (95% CI)): 18.11 ± 0.75 µg/L (16.64 – 19.58) (6 studies)
Colostrum (weighted mean ± SE (95% CI)): 258.00 ± 154.58 µg/L (14.97 – 560.98) (2 studies)
Transitional milk (weighted mean ± SE (95% CI)): 116.25 ± 13.07 µg/L (90.65 – 141.86) (2 studies)
Mature milk (weighted mean ± SE (95% CI)): 17.78 ± 0.75 µg/L (16.30 – 19.25) (5 studies)
Non supplemented women (weighted mean ± SE (95% CI)): 23.36 ± 0.91 µg/L (21.56 – 25.15) (3 studies)
Supplemented women (weighted mean ± SE (95% CI)): 5.37 ± 1.34 µg/L (2.74 – 8.00) (1 study)
All samples (weighted mean ± SE (95% CI)): 18.11 ± 0.75 µg/L (16.64 – 19.58)
(a)
Concentrations in retinol, alpha-carotene and beta-carotene are reported. When reported in the paper, total vitamin A concentrations, in retinol equivalent (RE) are reported, with
the conversion formula applied. When analysed forms were unspecified in the paper, “vitamin A” concentrations are reported.
Vitamin A breast milk concentration was assessed in 19 publications (18 studies) via the quantitation of retinol (8 studies), alpha-carotene (4 studies), beta-carotene
(6 studies). One study also calculated total vitamin A concentration in retinol equivalents (RE) (Olafsdottir, Wagner et al. 2001). Five studies reported “vitamin A”
concentration without specifying the analysed forms (Sanchez-Hidalgo, Flores-Huerta et al. 2000; Aurvag, Henriksen et al. 2007; Schweigert, Raila et al. 2011;
Szlagatys-Siodorkiewicz, Zagierski et al. 2012; Vähämiko, Isolauri et al. 2013). Nine studies were free of confounders (Gossage, Deyhim et al. 2002; Canfield,
Clandinin et al. 2003; Schweigert, Bathe et al. 2004; Schulz, Engel et al. 2007; Aurvag, Henriksen et al. 2007; Tijerina-Saenz, Innis et al. 2009; Tacken, Vogelsang
et al. 2009; Orhon, Ulukol et al. 2009; Szlagatys-Siodorkiewicz, Zagierski et al. 2012). The analytical method employed is HPLC (17 studies). One study did not
record the analytical method. Data are available for colostrum (2 studies), transitional milk (2 studies) or mature milk (6 samples). Milks were collected from
mothers who gave birth to both term (8 studies) and pre-term infants (1 study). In 4 of the studies, mothers were taking vitamin A supplement (as beta-carotene
ranging 1 to 30 mg/day (Gossage, Deyhim et al. 2002; Tacken, Vogelsang et al. 2009), retinol ranging 5.46 to 72.52 µg/day (Vähämiko, Isolauri et al. 2013) or 750
µg RE (Aurvag, Henriksen et al. 2007)).
Seven studies reported intake data (retinol from 792 to 4 965 µg, alpha-carotene 844 to 1 491 µg, beta-carotene 4 942 to 6 490 µg) (Olafsdottir, Wagner et al. 2001;
Gossage, Deyhim et al. 2002; Schulz, Engel et al. 2007; Aurvag, Henriksen et al. 2007; Duda, Nogala-Kalucka et al. 2009; Orhon, Ulukol et al. 2009; Vähämiko,
EFSA supporting publication 2014:EN-629
85
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Isolauri et al. 2013); 6 studies reported data on status as alpha-carotene, beta-carotene or retinol plasma concentration (Schweigert, Bathe et al. 2004; Schulz, Engel
et al. 2007; Aurvag, Henriksen et al. 2007; Tokusoglu, Tansug et al. 2008; Orhon, Ulukol et al. 2009; Vähämiko, Isolauri et al. 2013).
The weighted mean and 95% CI for retinol concentration from all samples was 206.06 (195.14 – 216.97) µg/L. Weighted means and 95% CIs at different stages of
lactation were the followings: colostrum = 1 353.03 (271.72 – 2434.34) µg/L; transitional milk = 2 380.97 (2 125.18 – 2 636.75) µg/L; mature milk = 228.55
(216.15 – 240.94) µg/L. Weighted mean and 95% CI was 233.74 (221.36 – 246.12) µg/L for milk of mothers of term infants. The weighted mean and 95% CI were
333.13 (317.12 – 349.15) µg/L for milk from non-supplemented women. There was no data on breast milk retinol concentration from supplemented women.
One study showed a correlation between the concentration of retinol in the milk and the intake of cod liver (Olafsdottir, Wagner et al. 2001), 1 study showed a
positive correlation between maternal vitamin A intakes (as measured by total vitamin A + retinol) and milk retinol levels and between maternal plasma and milk
beta-carotene levels in non-smoker mothers, but not in smoker ones (Orhon, Ulukol et al. 2009). Another study did not find correlation between breast milk vitamin
A concentration (not specified) and intake of beta-carotene (30 mg/day) (Gossage, Deyhim et al. 2000; Gossage, Deyhim et al. 2002). Two studies showed
correlation between maternal plasma retinol and milk concentrations (Schulz, Engel et al. 2007; Tokusoglu, Tansug et al. 2008). One study showed that levels of
carotenoids and vitamin A were highest in colostrum and declined (P<0.01) (Schweigert, Bathe et al. 2004).
EFSA supporting publication 2014:EN-629
86
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
4.4.2.
Vitamin B1
As described in the study flow diagram, 2 publications were recorded from the comprehensive literature search on vitamin B1 (January 2000 – January 2014).
Details are reported in the following Table 10.
Table 10: Summary of the included studies for vitamin B1
Publication
Ortega, Martinez
et al. 2004
Population main
characteristics
Spanish
mothers
infants
of
women
term
Supplementation
Maternal
micronutrients intake
Stage of lactation
Vitamin B1 intake
<
recommended
intake (RI) group:
Vitamin
B1
supplied
by
supplements:
0
mg/d;
Vitamin B1 intake <RI
group:
Total
intake
(diet): 0.87 ± 0.13 mg/d;
Transitional milk
(13-14 days);
Vitamin B1 intake
≥
recommended
intake (RI) group:
Vitamin
B1
supplied
by
supplements: 1.57
mg/d
Hampel, York et
al. 2012
Caucasian women
(from USA)
Not reported
EFSA supporting publication 2014:EN-629
Mature
days)
milk
Confounding
factors
No
Analytical
method
Fluorimetry
Vitamin B1
concentration in
breast milk
Number of
women
(number of
samples)
Mean ± SD: vitamin
B1 238.82 ± 273.32
µg/L;
Vitamin
B1
intake
<RI
group:
13
(20);
Vitamin
B1
intake
≥RI
group: 38 (21)
(40
Mean ± SD: vitamin
B1 66.34 ± 18.6 µg/L;
Vitamin B1 intake ≥RI
group:
Total
intake
(supplements + diet):
1.45 ± 0.38 mg/d
Transitional milk
(13-14 days);
Mean ± SD: vitamin
B1 233.51 ± 151.25
µg/L
Mature
days)
Mean ± SD: vitamin
B1 156.56 ± 116.76
µg/L
Not reported
Mature milk: 4-12
weeks
milk
(40
Yes:
Few
information
on
population
and
lack
of
information
on
specific
supplementation
UPLC–
MS/MS
Mean (range): Vitamin
B1: 37 (5-66) µg/L
28 (28)
87
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Publication
Population main
characteristics
Supplementation
Maternal
micronutrients intake
Stage of lactation
Confounding
factors
Analytical
method
Vitamin B1
concentration in
breast milk
Number of
women
(number of
samples)
Weighted mean analysis for vitamin B1 (vitamin B1) concentration in women milk (2 studies):
Mothers of term infants (weighted mean ± SE (95% CI)): 71.70 ± 18.17 µg/L (36.08 – 107.31) (1 study)
Transitional milk (weighted mean ± SE (95% CI)): 234.76 ± 132.34 µg/L (24.63 – 494.14) (1 study)
Mature milk (weighted mean ± SE (95% CI)): 68.57 ± 18.34 µg/L (32.61 – 104.52) (1 study)
Non supplemented women (weighted mean ± SE (95% CI)): 67.13 ± 18.53 µg/L (30.81 – 103.45) (1 study)
Supplemented women (weighted mean ± SE (95% CI)): 185.29 ± 92.42 µg/L (4.14 – 366.44) (1 study)
All samples (weighted mean ± SE (95% CI)): 44.73 ± 8.58 µg/L (27.92 – 61.54) (2 studies)
Vitamin B1 breast milk concentration was assessed in 2 studies. One study was free of confounders (Ortega, Martinez et al. 2004). The analytical method employed
was either HPLC (1 study) or fluorimetry (1 study). Data were available for colostrum (1 study), transitional milk (1 study), mature milk (1 study). Milks were
collected from mothers who gave birth to term infants in one study, while in the other study the gestation stage was not specified. In 1 of the studies, mothers were
taking vitamin B1 supplement (1.57 mg/day) (Ortega, Martinez et al. 2004). One study reported intake and status data (vitamin B1 status assessed by erythrocyte
transketolase activation assay) (Ortega, Martinez et al. 2004).
The weighted mean and 95% CI for vitamin B1 concentration from all samples was 44.73 (27.92 – 61.54) µg/L. Weighted means and 95% CIs at different stages of
lactation are the followings: transitional milk = 234.76 (24.63 – 494.14); mature milk = 68.57 (32.61 – 104.52). Milk from mothers of term infants presented
weighted mean and 95% CI concentration of 71.70 (36.08 – 107.31) µg/L. The weighted means and 95% CIs were 67.13 (30.81 – 103.45) µg/L for milk from nonsupplemented women vs. 185.29 (4.14 – 366.44) µg/L for milk from women supplemented with vitamin B1.
One study showed a correlation between the concentration of vitamin B1 in the mature milk and its intake (Ortega, Martinez et al. 2004). The relationship between
vitamin B1 intake/status and breast milk concentration was not investigated in the other study.
EFSA supporting publication 2014:EN-629
88
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
4.4.3.
Chloride
As described in the study flow diagram, 1 publication was recorded from the comprehensive literature search on chloride (January 2000 – January 2014). Details
are reported in the following Table 11.
Table 11: Summary of the included study for chloride
Publication
Population main
characteristics
Bauer, Gerss 2011
German
women
mothers of both
term and preterm
infants
Supplementation
Not reported
Maternal
micronutrients intake
Not reported
Stage of lactation
Confounding
factors
Mixed (1-8 weeks)
Yes:
No
information
on
supplementation
Analytical
method
Absorption
spectrometer
and
colorimetric
assay
Chloride
concentration in
breast milk
Number of
women
(number of
samples)
Mean ± SD: Chloride:
Preterm group (<28
weeks) 361.62 ± 81.54
mg/L
Total number
of
subjects:
102 (no data)
Mean ± SD: Chloride:
Preterm group (28-31
weeks)
443.16
±
106.36 mg/L
Mean ± SD: Chloride:
Preterm group (32-33
weeks) 361.62 ± 53.18
mg/L
Mean ± SD: Chloride:
Term group 386.44 ±
35.45 mg/L
Weighted mean analysis for chloride concentration in women milk (1 study):
Mothers of preterm infants (weighted mean ± SE (95% CI)): 373.79 ± 41.09 mg/L (293.26 – 454.32)
Mothers of term infants (weighted mean ± SE (95% CI)): 386.44 ± 35.45 mg/L (316.95 – 455.93)
All samples (weighted mean ± SE (95% CI)): 381.04 ± 26.84 mg/L (328.43 – 433.65)
EFSA supporting publication 2014:EN-629
89
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Chloride breast milk concentration was assessed in 1 study. The analytical method employed is spectrometric absorption. Milks samples were collected between 1
and 8 weeks post partum, from mothers who gave birth to both term and pre-term infants. There was no information on chloride intake/status in this study.
The weighted mean and 95% CI for chloride concentration from all samples was 381.04 (328.43 – 433.65) mg/L. Weighted means and 95% CIs were 373.79
(293.26 – 454.32) mg/L for mothers of preterm infants and 386.44 (316.95 – 455.93) mg/L for milk of mothers of term infants, respectively.The relationship
between chloride intake/status and breast milk concentration was not investigated in this study.
EFSA supporting publication 2014:EN-629
90
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
4.4.4.
Copper
As described in the study flow diagram, 3 publications were recorded from the comprehensive literature search on copper (January 2011 – January 2014). Details
are reported in the following Table 12.
Table 12: Summary of the included studies for copper
Publication
Population main
characteristics
Supplementation
Örün, Yalcin et al.
2012
Turkish
women
mothers of both
term and preterm
infants
Not reported
Björklund, Vahter
et al. 2012
Swedish women
Not reported
Maternal
micronutrients intake
Stage of lactation
Confounding
factors
Not reported
Mature milk (52-60
days postpartum)
Yes:
No
information
on
supplementation
Not reported
Mature milk: 14-21
days
Yes:
No
information
on
supplementation
Analytical
method
Copper concentration
in breast milk
Number of
women
(number of
samples)
ICP-MS
Median
(1st,
3rd
quartile): Copper: 239
(200; 296) µg/L
142 (no data)
ICP-MS
Mean ± SD:
60 (840)
Copper: 471 ± 75 µg/L
Median (range):
Copper: 471 (327 670) µg/L
WiniarskaMieczan, 2014
Polish women
Not reported
Not reported
Mature milk (1-12
months)
Yes:
No
information
on
supplementation
FAAS
Mean ± SD (range):
323 (323)
Copper: 137 ± 92 (25455) µg/L
Weighted mean analysis for copper concentration in women milk (3 studies):
All samples (weighted mean ± SE (95% CI)): 264.05 ± 29.29 µg/L (206.64 – 321.46) (3 studies)
Copper breast milk concentration was assessed in 3 studies. None of the studies was free of confounders. The analytical method employed is ICP-MS (2 studies) or
FAAS (1 study). All milk samples included mature milk. Samples from mothers of term and preterm infants were combined in 1 study (Örün, Yalcin et al. 2012);
the stage of gestation was not specified in the 2 other studies. There was no information on mothers’ supplementation with copper. None of the study reported
copper intake or status data.
The weighted mean and 95% CI for copper concentration from all samples was 264.05 (206.64 – 321.46) µg/L.
None of the studies investigated the relationship between chloride intake/status and breast milk concentration.
EFSA supporting publication 2014:EN-629
91
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
4.4.5.
Magnesium
As described in the study flow diagram, 3 publications were included from the comprehensive literature search on magnesium (October 2010 – January 2014).
Details are reported in the following Table 13.
Table 13: Summary of the included studies for magnesium
Publication
Population main
characteristics
Bauer, Gerss 2011
German
women
mothers of term and
preterm infants
Supplementation
Not reported
Maternal
micronutrients intake
Not reported
Stage of lactation
Confounding
factors
Analytical
method
Mixed (1-8 weeks)
Yes:
No
information
on
supplementation
Absorption
spectrometer
and
colorimetric
assay
with
endpoint
determination
Magnesium
concentration in
breast milk
Mean ± SD:
Magnesium: Preterm
group (<28 weeks)
38.89 ± 7.29 mg/L
Number of
women
(number of
samples)
Total number
of
subjects:
102 (no data)
Magnesium: Preterm
group (28-31 weeks)
36.46 ± 7.29 mg/L
Magnesium: Preterm
group (32-33 weeks)
41.32 ± 4.86 mg/L
Magnesium:
Term group 31.60 ±
4.86 mg/L
Witczak,
Jarnuszewska
al. 2011
Polish women
Not reported
Not reported
et
Björklund, Vahter
et al. 2012
Swedish women
Not reported
EFSA supporting publication 2014:EN-629
Not reported
Mature milk: 5-6
months
Yes:
lack
of
information
on
specific
supplementation
and population
ICP-AES
Mature milk: 14-21
days
Yes:
No
information
on
supplementation
ICP-MS
Mean:
Magnesium: 40 mg/L
Mean ± SD:
Not
(9)
reported
60 (840)
Magnesium: 28 ± 4.8
mg/L
92
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Median (range):
Magnesium: 28 (2143) mg/L
Weighted mean analysis for magnesium concentration in women milk (3 studies):
Mothers of preterm infants (weighted mean ± SE (95% CI)): 39.60 ± 3.54 mg/L (32.67 – 46.54) (1 study)
Mothers of term infants (weighted mean ± SE (95% CI)): 31.60 ± 4.86 mg/L (22.07 – 41.12) (1 study)
All samples (weighted mean ± SE (95% CI)): 34.83 ± 2.39 mg/L (30.15 – 39.51) (3 studies)
Magnesium breast milk concentration was assessed in 3 studies. None of the studies was free of confounders. The analytical method employed was absorption
spectrometry (1 study), ICP-AES (1 study) and ICP-MS (1 study). Milk samples included mature milk (2 studies) or mixed samples (1-8 weeks post partum; 1
study). One study provided milk concentrations from milk of mothers who gave birth to term vs. pre-term infants (Bauer, Gerss 2011); the other studies did not
specify the gestational age for the infants. There was no information on mothers’ supplementation with magnesium. None of the studies reported intake or status
data.
The weighted mean and 95% CI for magnesium concentration from all samples was 34.83 (30.15 – 39.51) mg/L. Weighted means and 95% CIs was 39.60 (32.67 –
46.54) mg/L for milk of mothers of preterm infants and 31.60 (22.07 – 41.12) mg/L for milk of mothers of term infants, respectively.
None of the studies investigated the relationship between magnesium intake/status and breast milk concentration.
EFSA supporting publication 2014:EN-629
93
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
4.4.6.
Sodium
As described in the study flow diagram, 13 publications were included from the comprehensive literature search on sodium (January 2000 – January 2014). Details
are reported in the following Table 14.
Table 14: Summary of the included studies for sodium
Publication
Population main
characteristics
Gulson, Mizon et
al. 2001
6 Australian and 31
migrants selected at
the start of the
study, 17 women
were
finally
included
Supplementation
Not reported
Maternal
micronutrients intake
Sodium - no data
Stage of lactation
Not reported
Daily intakes (mean): P:
606 mg (nonpregnant
migrants),
788
mg
(pregnant migrants), 940
mg (Australian pregnant
subjects).
Confounding
factors
Yes:
No
information
on
supplementation
Analytical
method
Not reported
Sodium concentration
in breast milk
Mean ± SD:
Number of
women
(number of
samples)
17 (78)
Sodium: 167 ± 62.37
mg/L;
Median:
Sodium: 170 mg/L
Daily intakes (mean): K:
1392 mg (nonpregnant
migrants), 1710 mg
(pregnant
migrants),
1938 mg (Australian
pregnant subjects).
Kumral, Duman
et al. 2002
Turkish
mothers
infants
of
women
term
Not reported
Not reported
Transitional milk (5
days)
Transitional milk (7
days)
Yes: The lack of
information
on
specific
supplementation
Not reported
Sodium
values):
(Individual
1 (2)
Transitional milk (5
days): 1908.17 mg/L
(right breast); 1793.22
mg/L (left breast)
Sodium
values):
(Individual
1 (2)
Transitional milk (7
days): 1586.31 mg/L
EFSA supporting publication 2014:EN-629
94
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
(right
breast);
1632.29 (left breast)
mg/L
Tarcan, Tiker et
al. 2005
Savilahti,
Saarinen et
2007
al.
Turkish
mothers
infants
Finnish
mothers
infants
of
of
women
term
women
term
Not reported
Not reported
Not reported
Not reported
Mixed (group
3-20 days)
1:
Mixed (group
3-17 days)
2:
Mixed (group
3-12 days)
3:
Colostrum
days)
Yes:
Few
information
on
population
and
lack
of
information
on
specific
supplementation
Not reported
Mean ± SD (range):
Sodium
Group 1*: 581.65 ±
337.95 (91.96-1793.22)
mg/L
Sodium
Group 2*: 540.27 ±
268.98
(137.941034.55) mg/L
Sodium
Group 3*: 866.72 ±
262.09
(436.811379.40) mg/L
(1-5
Yes: Population asthma (18 vs
13%)
and
symptoms
of
atopy (48%). No
information
on
supplementation
Not reported
Mean:
Sodium
Mothers who either
breast-fed their infants
exclusively less than
0.5 months: 597.74
mg/L
Sodium
Mothers who either
breast-fed their infants
exclusively longer than
3.5 months: 459.80
mg/L
EFSA supporting publication 2014:EN-629
group 1: 58
(58)
group 2: 18
(18)
group 3: 10
(10)
Mothers who
either breastfed
their
infants
exclusively
less than 0.5
months:
96
(96)
Mothers who
either breastfed
their
infants
exclusively
longer
than
3.5
months:
106 (106)
95
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Manganaro,
Marseglia et al.
2007
Italian
mothers
infants
women
term
Not reported
Not reported
Colostrum (3 days)
Yes:
No
information
on
supplementation
Flame
photometer
IL943
Mean ± SD (95% CI):
Sodium: 540.27 ±
25.29 (479.80-580.50)
mg/L
208 (208)
of
Ozbek. Kumral et
al. 2008
Turkish
mothers
infants
women
term
Not reported
Not reported
Mixed (mean ± SD:
4.48 ± 1.63 days)
Yes:
No
information
on
supplementation
Ion selective
method
in
Hitachi
Modular
Analytics ISE
1900 module
Mean ± SD:
of
Hypernatremic
dehydration
group:
21
(21);
Sodium
Hypernatremic
dehydration
group:
1040.76 ± 435.20 mg/L
(for information, not
taken into account in
the analyses)
Sodium
Control group: 283.47
± 91.27 mg/L
Powe, Puopolo et
al. 2010
Campbell-Yeo,
Allen et al. 2010
American women
mothers of preterm
infants
Canadian women
mothers of preterm
infants
Not reported
Not reported
Not reported
Not reported
Mature milk (4-39
weeks)
Colostrum (day 0)
Transitional
(day 14)
Orgun, Atlihan et
al. 2010
Turkish
mothers
infants
of
women
term
Not reported
EFSA supporting publication 2014:EN-629
Not reported
Not reported
milk
Yes:
Few
information
on
population
and
lack
of
information
on
specific
supplementation
Flame
photometry
Yes:
Few
information
on
population
and
lack
of
information
on
specific
supplementation
Not reported
Yes:
Few
information
on
population
and
lack
of
Not reported
Mean:
Control group:
43 (43)
2 (4)
Sodium
Baseline: days 1 and 2:
183.92 mg/L
Pooled data from days
7 and 8: 160.93 mg/L
Mean ± SD:
Sodium: 363.24
374.74 mg/L
±
Sodium: 395.43
446.01 mg/L
±
Mean ± SD:
Sodium
Placebo
group: 24 (48)
Hypernatremic
dehydration
group: 50 (50)
Hypernatremic
96
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
information
on
specific
supplementation
dehydration
group:
558.66 ± 466.7 mg/L
(for information, not
taken into account in
the analyses)
Sodium
Control group: 278.18
± 193.12 mg/L
Bauer, Gerss 2011
German
women
mothers of term and
preterm infants
Not reported
Not reported
Mixed (1-8 weeks)
Yes:
No
information
on
supplementation
Absorption
spectrometer
and
colorimetric
assay
with
endpoint
determination
Mean ± SD:
Sodium:
Preterm group (<28
weeks) 243.69 ± 43.68
mg/L
Control group:
72 (72)
Total number
of
subjects:
102 (no data)
Sodium:
Preterm group (28-31
weeks) 243.69 ± 50.58
mg/L
Sodium:
Preterm group (32-33
weeks) 239.10 ± 43.68
mg/L
Sodium:
Term group 257.49 ±
48.28 mg/L
Galipeau, Goulet
et al. 2012
North
American:
91; European: 11;
Asian: 6; African:
14; Central/South
American:
6;
Caribbean:
11;
Middle East: 2 (in
Canada)
Women
of
Not reported
Not reported
Mixed: colostrum
(3
days)
and
transitional milk (2
weeks)
Yes:
No
information
on
supplementation
Gasometry
apparatus
Mean ± SD (range):
Sodium: 982.36 ±
508.54
(333.362758.80) mg/L
151 (151)
term
EFSA supporting publication 2014:EN-629
97
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
infants
Björklund, Vahter
et al. 2012
Swedish women
Not reported
Not reported
Mature milk: 14-21
days
Yes:
No
information
on
supplementation
ICP-MS
Mean ± SD:
60 (840)
Sodium: 0.217±0.077
mg/L
Median (range):
Sodium: 0.192 (0.1360.48) mg/L
Weighted mean analysis for sodium concentration in women milk (12 studies):
Mothers of preterm infants (weighted mean ± SE (95% CI)): 183.58 ± 11.00 mg/L (162.02 – 205.13) (3 studies)
Mothers of term infants (weighted mean ± SE (95% CI)): 850.35 ± 17.15 mg/L (816.73 – 883.98) (8 studies)
Colostrum (weighted mean ± SE (95% CI)): 538.18 ± 24.37 mg/L (490.42 – 585.94) (2 studies)
Transitional milk (weighted mean ± SE (95% CI)): 1642.60 ± 30.19 mg/L (1583.43 – 1701.76) (1 study)
All samples (weighted mean ± SE (95% CI)): 371.07 ± 9.09 mg/L (353.25 – 388.89) (12 studies)
*Group 1: babies who exhibited <10% weight loss or had regained to reach birthweight (minimum) in the period up to postnatal day 10; Group 2: babies who showed >10% weight
loss or had not regained enough to reach birthweight by postnatal day 10, and whose serum Na levels were <146 mEq/L; Group 3: babies with the same weight status as group 2
(severe weight loss), but whose serum Na levels were ≥146 mEq/L.
Sodium breast milk concentration was assessed in 12 publications. None of the studies was free of confounders. The analytical method employed is flame
photometry (2 studies), absorption spectrometry (1 study), gasometry (1 study), ICP-MS (1 study) and ion selective method (1 study). Six studies did not record the
analytical method. Milk samples included colostrum (3 studies), transitional milk (2 studies), mature milk (2 studies) or mixed/unspecified samples (6 studies)
(weighed mean analysis according to stage of lactation was only performed when it was specified that women gave birth to term infants). Milk concentrations were
available from mothers who gave birth to term infants (8 studies) or pre-term infants (3 studies); the stage of gestation was not specified in 2 studies. None of the
studies reported mothers’ sodium intake or status data.
The weighted mean and 95% CI for sodium concentration from all samples was 371.07 (353.25 – 388.89) mg/L. Weighted means and 95% CIs at different stages
of lactation are the followings: colostrum = 538.18 (490.42 – 585.94) mg/L; transitional milk = 1642.60 (1583.43 – 1701.76) mg/L. Weighted means and 95% CIs
were 183.58 (162.02 – 205.13) mg/L in milks from mothers of preterm infants and 850.35 (816.73 – 883.98) mg/L in milks from mothers of term infants,
respectively.
None of the studies investigated the relationship between sodium intake/status and breast milk concentration.
EFSA supporting publication 2014:EN-629
98
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the
author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European
Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
CONCLUSIONS
Articles have been systematically searched and reviewed using a standard protocol, with the aim of
collating data on breast milk concentrations of folate, zinc, vitamin B6, vitamin E, choline,
phosphorus, vitamin A, vitamin B1, chloride, sodium (from January 2000), potassium, magnesium
(from October 2010) and copper (from January 2011).
The searches resulted in the inclusion of eight studies on folate, 41 studies on zinc, four studies on
vitamin B6, 23 studies on vitamin E, five studies on choline, five studies on phosphorus, three studies
on potassium, 18 studies on vitamin A, two studies on vitamin B1, one study on chloride, three studies
on copper, three studies on magnesium and 12 studies on sodium.
Weighted mean breastmilk concentrations for each individual micronutrient were calculated by
combining results from “all samples” available. The characteristics of the breast milk samples assessed
in these studies were diverse (i.e. samples from mothers of term vs. preterm infants; colostrum,
transitional milk or mature milk samples; samples from mothers supplemented with the micronutrient
of interest or not). This heterogeneity should be kept in mind when interpreting the results of the
pooled analyses.
A number of studies were assessed as being at moderate risk of bias due to uncertainties regarding the
characteristics of the breast milk samples (i.e. mothers’ supplementation with the micronutrient of
interest, infants’ gestational age at birth and/or lactation stage not reported). Overall, two out of eight
studies on folate, six out of 41 studies on zinc, three out of four studies on vitamin B6, five out of 23
studies on vitamin E, two out of five studies on choline, one out of five studies for phosphorus, none
out of three studies for potassium, nine out of 18 studies for vitamin A, one out of two studies on
vitamin B1, none out of three studies for copper, none out of three studies on magnesium, and none
out of 12 studies on sodium were assessed as “free of confounders” and provided adequate
characterisation of the breast milk samples. The results of the other studies could not be used in
refined weighted mean analyses performed according to stages of lactation, gestational age at birth,
and use or not of the supplement of interest. The lack of information on the characteristics of breast
milk samples in most studies limit the exploration of heterogeneity among results.
The reliability of analytical methods applied was assessed for each study according to the presence of
quality controls and sufficient details on the validation. No technical issue was identified and there
was sufficient information on the methods used to consider them as reliable. When several methods
were used for dosing the same micronutrient, data recorded from the studies did not allow estimating
the relevancy/usefulness of one method compared to another. For some studies, there were strong
doubts with respect to the units recorded in the publication; results from these studies were reported in
the database but were not included in the analyses.
EFSA supporting publication 2014:EN-629
99
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively
by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender
procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be
considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the
issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
REFERENCES INCLUDED
Folates
Alvarez-Sanchez, B., Priego-Capote, F. et al. (2010). "Automated determination of folate catabolites
in human biofluids (urine, breast milk and serum) by on-line SPE-HILIC-MS/MS." Journal of
Chromatography A 1217(28): 4688-4695.
Buttner, B. E., Witthoft, C. M. et al. (2014). "Effect of type of heat treatment of breastmilk on folate
content and pattern." Breastfeeding Medicine 9(2): 86-91.
Houghton, L. A., Yang, J. et al. (2009). "Unmetabolized folic acid and total folate concentrations in
breast milk are unaffected by low-dose folate supplements." American Journal of Clinical Nutrition
89(1): 216-220.
Khambalia, A., Latulippe, M. E. et al. (2006). "Milk folate secretion is not impaired during iron
deficiency in humans." Journal of Nutrition 136(10): 2617-2624.
Kim, T. H., Yang, J. et al. (2004). "A large pool of available folate exists in the large intestine of
human infants and piglets." Journal of Nutrition 134(6): 1389-1394.
Sanchez-Hidalgo, V. M., Flores-Huerta, S. et al. (2000). "A fortifier comprising protein, vitamins, and
calcium-glycerophosphate for preterm human milk." Archives of Medical Research 31(6): 564570.
Villalpando, S., Latulippe, M. E. et al. (2003). "Milk folate but not milk iron concentrations may be
inadequate for some infants in a rural farming community in San Mateo, Capulhuac, Mexico."
American Journal of Clinical Nutrition 78(4): 782-789.
West, A. A., Yan, J. et al. (2012). "Folate-status response to a controlled folate intake in nonpregnant,
pregnant, and lactating women." American Journal of Clinical Nutrition 96(4): 789-800.
Yan, J., Jiang, X. et al. (2012). "Maternal choline intake modulates maternal and fetal biomarkers of
choline metabolism in humans." Am J Clin Nutr 95(5): 1060-1071.
Zinc
Almeida, A. A., Lopes, C. M. P. V. et al. (2008). "Trace elements in human milk: Correlation with
blood levels, inter-element correlations and changes in concentration during the first month of
lactation." Journal of Trace Elements in Medicine and Biology 22(3): 196-205.
Bieri, A., Petkovic, V. et al. (2013). "Short stature and GH deficiency caused by zinc deficiency in a 6month-old breast-fed infant due to a dominant negative heterozygous G87R mutation in the Zinc
Transporter ZnT-2 (SLC30A2) in the mother." Hormone Research in Paediatrics 80: 154-155.
Bjorklund, K. L., Vahter, M. et al. (2012). "Metals and trace element concentrations in breast milk of
first time healthy mothers: A biological monitoring study." Environmental Health: A Global
Access Science Source 11: 92.
EFSA supporting publication 2014:EN-629
100
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively
by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender
procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be
considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the
issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Bocca, B., Alimonti, A. et al. (2000). Nutritive significance of element speciation in breast milk: The
case of calcium, copper, iron, magnesium, manganese, and zinc. Advances in Experimental
Medicine and Biology. 478: 385-386.
Bosscher, D., Van Caillie-Bertrand, M. et al. (2001). "In vitro availability of calcium, iron, and zinc
from first-age infant formulae and human milk." Journal of Pediatric Gastroenterology and
Nutrition 32(1): 54-58.
Bosscher, D., Van, C. B. et al. (2003). "Availabilities of calcium, iron, and zinc from dairy infant
formulas is affected by soluble dietary fibers and modified starch fractions." Nutrition 19(7/8):
641-645.
Chowanadisai, W., Lonnerdal, B. et al. (2006). "Identification of a mutation in SLC30A2 (ZnT-2) in
women with low milk zinc concentration that results in transient neonatal zinc deficiency." Journal
of Biological Chemistry 281(51): 39699-39707.
Coelho, S., Fernandes, B. et al. (2006). "Transient zinc deficiency in a breast fed, premature infant."
European Journal of Dermatology 16(2): 193-195.
Domellof, M., Hernell, O. et al. (2004). Factors influencing concentrations of iron, zinc, and copper in
human milk. Advances in Experimental Medicine and Biology. 554: 355-358.
Domellof, M., Lonnerdal, B. et al. (2004). "Iron, zinc, and copper concentrations in breast milk are
independent of maternal mineral status." American Journal of Clinical Nutrition 79(1): 111-115.
Elmastas, M., Can, M. et al. (2005). "Determinations of copper, zinc, cadmium, and nickel in cows',
goats', ewes', and human milk samples using flame atomic absorption spectrometry (FAAS)
microwave digestion." Analytical Letters 38(1): 157-165.
Etcheverry, P., Wallingford, J. C. et al. (2004). "Calcium, zinc, and iron bioavailabilities from a
commercial human milk fortifier: a comparison study." J. Dairy Sci. 87: 3629-3637.
Gass, J. K., Hafiji, J. et al. (2010). "Acrodermatitis due to zinc-deficient breast milk." British Journal
of Dermatology 162(5): 1164-1165.
Guillot, I., Roth, B. et al. (2003). Acquired zinc deficiency in a breast-fed premature infant. Archives
de Pediatrie
Deficit acquis en zinc chez un premature nourri au sein. 10: 442-444.
Gulson, B. L., Mizon, K. J. et al. (2001). "Dietary intakes of selected elements from longitudinal 6-day
duplicate diets for pregnant and nonpregnant subjects and elemental concentrations of breast milk
and infant formula." Environmental Research 87(3): 160-174.
Hannan, M. A., Faraji, B. et al. (2009). "Maternal milk concentration of zinc, iron, selenium, and
iodine and its relationship to dietary intakes." Biological Trace Element Research 127(1): 6-15.
Hendricks, G. M., Guo, M. R. et al. (2001). "Solubility and relative absorption of copper, iron, and
zinc in two milk-based liquid infant formulae." International Journal of Food Sciences and
Nutrition 52: 419-428.
Kantola, M. and Vartiainen, T. (2001). "Changes in selenium, zinc, copper and cadmium
concentrations in human milk during the time when selenium has been supplemented to fertilizers
in Finland." J. Trace Elem. Med. Biol. 15: 11-17.
EFSA supporting publication 2014:EN-629
101
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively
by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender
procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be
considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the
issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Kienast, A., Roth, B. et al. (2007). "Zinc-deficiency dermatitis in breast-fed infants." European Journal
of Pediatrics 166(3): 189-194.
Leotsinidis, M., Alexopoulos, A. et al. (2005). "Toxic and essential trace elements in human milk from
Greek lactating women: Association with dietary habits and other factors." Chemosphere 61(2):
238-247.
Leverkus, M., Kutt, S. et al. (2006). "Nutritional zinc deficiency mimicking acrodermatitis
enteropathica in a fully breast-fed infant [36]." Journal of the European Academy of Dermatology
and Venereology 20(10): 1380-1381.
Mandato, F., Rubegni, P. et al. (2009). "A case of transient zinc deficiency in a breast-fed preterm
infant successfully treated with oral zinc supplementation: Review of zinc methabolism and related
diseases." Giornale Italiano di Dermatologia e Venereologia 144(6): 729-734.
Matos, C., Moutinho, C. et al. (2009). "Total antioxidant activity and trace elements in human milk:
the first 4 months of breast-feeding." Eur Food Res Technol 230: 201-208.
Milacic, R., Ajlec, D. et al. (2012). "Determination of Zn-citrate in human milk by CIM monolithic
chromatography with atomic and mass spectrometry detection." Talanta 101: 203-210.
Miletta, M. C., Bieri, A. et al. (2013). "Transient Neonatal Zinc Deficiency Caused by a Heterozygous
G87R Mutation in the Zinc Transporter ZnT-2 (SLC30A2) Gene in the Mother Highlighting the
Importance of Zn (2+) for Normal Growth and Development." International Journal of
Endocrinology 2013: 259189.
O'Brien, C. E., Krebs, N. F. et al. (2007). "Relationships among plasma zinc, plasma prolactin, milk
transfer, and milk zinc in lactating women." Journal of Human Lactation 23(2): 179-183.
Orun, E., Songul Yalcin, S. et al. (2012). "Zinc and copper concentrations in breastmilk at the second
month of lactation." Indian Pediatrics 49(2): 133-135.
Piotrowska-Dept, J. Piotrowska-Jastrzebska, et al. (2006). Zinc concentration in breast-milk of women
living in Podlasie. Pediatria Wspolczesna Zawartosc cynku w mleku kobiet karmiacych piersia
zamieszkalych na terenie Podlasia. 8: 121-125.
Rodriguez Rodriguez, E. M., Sanz Alaejos, M. et al. (2000). "Concentrations of iron, copper and zinc
in human milk and powdered infant formula." International Journal of Food Sciences and Nutrition
51(5): 373-380.
Sanchez-Hidalgo, V. M., Flores-Huerta, S. et al. (2000). "A fortifier comprising protein, vitamins, and
calcium-glycerophosphate for preterm human milk." Archives of Medical Research 31(6): 564570.
Sievers, E. and Schaub, J. (2004). Zinc concentration in human milk: Longitudinal studies in
consecutive lactation periods. Advances in Experimental Medicine and Biology. 554: 403-405.
Silvestre, D., Martinez-Costa, C. et al. (2001). "Copper, iron, and zinc concentrations in human milk
during the first three months of lactation: A longitudinal study." Biological Trace Element
Research 80(1): 1-11.
Silvestre, M., Lagarda, M. et al. (2000). "Copper, iron and zinc determinations in human milk using
FAAS with microwave digestion." Food Chemistry 68: 95-99.
EFSA supporting publication 2014:EN-629
102
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively
by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender
procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be
considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the
issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Silvestre, M. D., Lagarda, M. J. et al. (2000). "A study of factors that may influence the determination
of copper, iron, and zinc in human milk during sampling and in sample individuals." Biological
Trace Element Research 76(3): 217-227.
Spevackova, V., Rychlik, S. et al. (2005). "Monitoring of trace elements in breast milk sampling and
measurement procedures." Central European Journal of Public Health 13(2): 85-88.
Stawarz, R., Formicki, G. et al. (2007). "Daily fluctuations and distribution of xenobiotics, nutritional
and biogenic elements in human milk in Southern Poland." Journal of Environmental Science and
Health - Part A Toxic/Hazardous Substances and Environmental Engineering 42(8): 1169-1175.
Turan, S., Saygi, S. et al. (2001). "Determination of heavy metal concentrations in human colostrum
samples by electrothermal atomic absorption spectrophotometry." Journal of Tropical Pediatrics
47(2): 81-85.
Ustundag, B., Yilmaz, E. et al. (2005). "Levels of cytokines (IL-1(beta), IL-2, IL-6, IL-8, TNF(alpha)) and trace elements (Zn, Cu) in breast milk from mothers of preterm and term infants."
Mediators of Inflammation 2005(6): 331-336.
Wasowicz, W., Gromadzinska, J. et al. (2001). "Selenium, zinc, and copper concentrations in the
blood and milk of lactating women." Biological Trace Element Research 79(3): 221-233.
Winiarska-Mieczan, A. (2014). "Cadmium, lead, copper and zinc in breast milk in Poland." Biol Trace
Elem Res 157(1): 36-44.
Yalcin, S. S., Yurdakok, K. et al. (2010). "Maternal and environmental determinants of breast-milk
mercury concentrations." Turkish Journal of Pediatrics 52(1): 1-9.
Yalcn, S. S., Baykan, A. et al. (2009). "The factors that affect milk-to-serum ratio for iron during early
lactation." Journal of Pediatric Hematology/Oncology 31(2): 85-90.
Vitamin B6
Boylan, L., Hart, S. et al. (2002). "Vitamin B-6 concentration of breast milk and neonatal behavioral
functioning." Journal of the American Dietetic Association 102: 1433-1438.
Chang, S. and Kirksey, A. (2002). "Vitamin B-6 status of breast-fed infants in relation to pyridoxine
center dot HCl supplementation of mothers." J Nutr Sci Vitaminol 48: 10-17.
Hampel, D., York, E. R. et al. (2012). "Ultra-performance liquid chromatography tandem massspectrometry (UPLC-MS/MS) for the rapid, simultaneous analysis of thiamin, riboflavin, flavin
adenine dinucleotide, nicotinamide and pyridoxal in human milk." Journal of Chromatography B:
Analytical Technologies in the Biomedical and Life Sciences 903: 7-13.
Lovelady, C. A., Williams, J. P. et al. (2001). "Effect of energy restriction and exercise on vitamin B-6
status of women during lactation." Medicine and Science in Sports and Exercise 33(4): 512-518.
EFSA supporting publication 2014:EN-629
103
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively
by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender
procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be
considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the
issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Vitamin E
Antonakou, A., Chiou, A. et al. (2011). "Breast milk tocopherol concentration during the first six
months in exclusively breastfeeding Greek women." European Journal of Nutrition 50(3): 195-202.
Duda, G., Nogala-Kalucka, M. et al. (2009). "Influence of the lactating women diet on the
concentration of the lipophilic vitamins in human milk." Pakistan Journal of Nutrition 8(5): 629634.
Elisia, I. and Kitts, D. D. (2011). "Quantification of hexanal as an index of lipid oxidation in human
milk and association with antioxidant components." Journal of Clinical Biochemistry and Nutrition
49(3): 147-152.
Gossage, C., Deyhim, M. et al. (2000). "Effect of (beta)-carotene supplementation and lactation on
carotenoid metabolism and mitogenic T lymphocyte proliferation." American Journal of Clinical
Nutrition 71(4): 950-955.
Gossage, C. P., Deyhim, M. et al. (2002). "Carotenoid composition of human milk during the first
month postpartum and the response to (beta)-carotene supplementation." American Journal of
Clinical Nutrition 76(1): 193-197.
Jewell, V. C., Mayes, C. B. D. et al. (2004). "A comparison of lutein and zeaxanthin concentrations in
formula and human milk samples from Northern Ireland mothers." European Journal of Clinical
Nutrition 58(1): 90-97.
Kasparova, M., Plisek, J. et al. (2012). "Rapid sample preparation procedure for determination of
retinol and alpha-tocopherol in human breast milk." Talanta 93: 147-152.
Martysiak-Zurowska, D., Szlagatys-Sidorkiewicz, A. et al. (2013). "Concentrations of alpha- and
gamma-tocopherols in human breast milk during the first months of lactation and in infant
formulas." Maternal and Child Nutrition 9(4): 473-482.
Michalski, M. C., Calzada, C. et al. (2008). "Oxidation products of polyunsaturated fatty acids in
infant formulas compared to human milk--a preliminary study." Mol. Nutr. Food Res. 52: 14781485.
Molto-Puigmarti, C., Castellote, A. I. et al. (2009). "Ultra-High-Pressure Liquid Chromatographic
method for the analysis of tocopherols in human colostrum and milk." Journal of Chromatography
A 1216(20): 4388-4394.
Molto-Puigmarti, C., Permanyer, M. et al. (2011). "Effects of pasteurisation and high-pressure
processing on vitamin C, tocopherols and fatty acids in mature human milk." Food Chemistry
124(3): 697-702.
Olafsdottir, A. S., Wagner, K. H. et al. (2001). "Fat-soluble vitamins in the maternal diet, influence of
cod liver oil supplementation and impact of the maternal diet on human milk composition." Annals
of Nutrition and Metabolism 45(6): 265-272.
Orhon, F. S., Ulukol, B., et al. (2009). "The influence of maternal smoking on maternal and newborn
oxidant and antioxidant status." European Journal of Pediatrics 168(8): 975-981.
EFSA supporting publication 2014:EN-629
104
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively
by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender
procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be
considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the
issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Quiles, J. L., Ochoa, J. J. et al. (2006). "Coenzyme Q concentration and total antioxidant capacity of
human milk at different stages of lactation in mothers of preterm and full-term infants." Free
Radical Research 40(2): 199-206.
Romeu-Nadal, M., Castellote, A. I. et al. (2008). "Effect of pasteurisation on ascorbic acid,
dehydroascorbic acid, tocopherols and fatty acids in pooled mature human milk." Food Chemistry
107(1): 434-438.
Romeu-Nadal, M., Castellote, A. I. et al. (2008). "Effect of cold storage on vitamins C and E and fatty
acids in human milk." Food Chemistry 106(1): 65-70.
Romeu-Nadal, M., Morera-Pons, S. et al. (2006). "Determination of gamma- and alpha-tocopherols in
human milk by a direct high-performance liquid chromatographic method with UV-vis detection
and comparison with evaporative light scattering detection." Journal of Chromatography A 1114:
132-137.
Schweigert, F. J., Bathe, K. et al. (2004). "Effect of the stage of lactation in humans on carotenoid
levels in milk, blood plasma and plasma lipoprotein fractions." European Journal of Nutrition
43(1): 39-44.
Sziklai-Laszlo, I., Majchrzak, D. et al. (2009). "Selenium and vitamin e concentrations in human milk
and formula milk from Hungary." Journal of Radioanalytical and Nuclear Chemistry 279(2): 585590.
Szlagatys-Sidorkiewicz, A., Zagierski, M. et al. (2012). "Longitudinal study of vitamins A, E and lipid
oxidative damage in human milk throughout lactation." Early Human Development 88(6): 421-424.
Thijssen, H. H. W., Drittij, M. J. et al. (2002). "Menaquinone-4 in breast milk is derived from dietary
phylloquinone." British Journal of Nutrition 87(3): 219-226.
Tijerina-Saenz, A., Innis, S. M. et al. (2009). "Antioxidant capacity of human milk and its association
with vitamins A and e and fatty acid composition." Acta Paediatrica, International Journal of
Paediatrics 98(11): 1793-1798.
Tokusoglu, O., Tansug, N. et al. (2008). "Retinol and (alpha)-tocopherol concentrations in breast milk
of Turkish lactating mothers under different socio-economic status." International Journal of Food
Sciences and Nutrition 59(2): 166-174.
Vahamiko, S., Isolauri, E. et al. (2013). "The impact of dietary counselling during pregnancy on
vitamin intake and status of women and their children." International Journal of Food Sciences and
Nutrition 64(5): 638-647.
Choline
Fischer, L. M., Da Costa, K. A. et al. (2010). "Choline intake and genetic polymorphisms influence
choline metabolite concentrations in human breast milk and plasma." American Journal of Clinical
Nutrition 92(2): 336-346.
Holmes, H. C., Snodgrass, G. J. A. I. et al. (2000). "Changes in the choline concentration of human
breast milk in the first 3 weeks after birth." European Journal of Pediatrics 159(3): 198-204.
EFSA supporting publication 2014:EN-629
105
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively
by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender
procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be
considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the
issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Ilcol, Y. O., Ozbek, R. et al. (2005). "Choline status in newborns, infants, children, breast-feeding
women, breast-fed infants and human breast milk." Journal of Nutritional Biochemistry 16(8): 489499.
Ozarda, Y., Cansev, M., et al. (2014). "Breast milk choline contents are associated with inflammatory
status of breastfeeding women." Journal of Human Lactation 30(2): 161-166.
Ozarda, Y., Cansev, M., et al. (2014). "Relations of human breastmilk choline content with maternal
hormonal status." Breastfeeding Medicine 9(1): 39-41.
Phosphorus
Bjorklund, K. L., Vahter, M. et al. (2012). "Metals and trace element concentrations in breast milk of
first time healthy mothers: A biological monitoring study." Environmental Health: A Global
Access Science Source 11(1): 92.
Gulson, B. L., Mizon, K. J. et al. (2001). "Dietary intakes of selected elements from longitudinal 6-day
duplicate diets for pregnant and nonpregnant subjects and elemental concentrations of breast milk
and infant formula." Environmental Research 87(3): 160-174.
Nickkho-Amiry, M., Prentice, A. et al. (2008). "Maternal vitamin D status and breast milk
concentrations of calcium and phosphorus [1]." Archives of Disease in Childhood 93(2): 179.
Sanchez-Hidalgo, V. M., Flores-Huerta, S. et al. (2000). "A fortifier comprising protein, vitamins, and
calcium-glycerophosphate for preterm human milk." Archives of Medical Research 31(6): 564570.
Witczak, A. and Jarnuszewska, A. (2011). "[The concentration of selected mineral nutrients in infant
and follow-on formulae available at retail stores in Szczecin]." ROCZN. PZH 62(3): 257-262.
Potassium
Bauer, J. and Gerss, J. (2011). "Longitudinal analysis of macronutrients and minerals in human milk
produced by mothers of preterm infants." Clin Nutr 30(2): 215-220.
Bjorklund, K. L., Vahter, M. et al. (2012). "Metals and trace element concentrations in breast milk of
first time healthy mothers: A biological monitoring study." Environmental Health: A Global
Access Science Source 11(1): 92.
Witczak, A. and Jarnuszewska, A. (2011). "[The concentration of selected mineral nutrients in infant
and follow-on formulae available at retail stores in Szczecin]." ROCZN. PZH 62(3): 257-262.
Vitamin A
Aurvag, A. K., Henriksen, C. et al. (2007). "Improved vitamin A supplementation regimen for
breastfed very low birth weight infants." Acta Paediatrica, International Journal of Paediatrics
96(9): 1296-1302.
EFSA supporting publication 2014:EN-629
106
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively
by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender
procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be
considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the
issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Canfield, L. M., Clandinin, M. T. et al. (2003). "Multinational study of major breast milk carotenoids
of healthy mothers." European Journal of Nutrition 42(3): 133-141.
Duda, G., Nogala-Kalucka, M. et al. (2009). "Influence of the lactating women diet on the
concentration of the lipophilic vitamins in human milk." Pakistan Journal of Nutrition 8(5): 629634.
Gossage, C., Deyhim, M. et al. (2000). "Effect of (beta)-carotene supplementation and lactation on
carotenoid metabolism and mitogenic T lymphocyte proliferation." American Journal of Clinical
Nutrition 71(4): 950-955.
Gossage, C. P., Deyhim, M. et al. (2002). "Carotenoid composition of human milk during the first
month postpartum and the response to (beta)-carotene supplementation." American Journal of
Clinical Nutrition 76(1): 193-197.
Jewell, V. C., Mayes, C. B. D. et al. (2004). "A comparison of lutein and zeaxanthin concentrations in
formula and human milk samples from Northern Ireland mothers." European Journal of Clinical
Nutrition 58(1): 90-97.
Kasparova, M., Plisek, J. et al. (2012). "Rapid sample preparation procedure for determination of
retinol and alpha-tocopherol in human breast milk." Talanta 93: 147-152.
Olafsdottir, A. S., Wagner, K. H. et al. (2001). "Fat-soluble vitamins in the maternal diet, influence of
cod liver oil supplementation and impact of the maternal diet on human milk composition." Annals
of Nutrition and Metabolism 45(6): 265-272.
Orhon, F. S., Ulukol, B., et al. (2009). "The influence of maternal smoking on maternal and newborn
oxidant and antioxidant status." European Journal of Pediatrics 168(8): 975-981.
Sanchez-Hidalgo, V. M., Flores-Huerta, S. et al. (2000). "A fortifier comprising protein, vitamins, and
calcium-glycerophosphate for preterm human milk." Archives of Medical Research 31(6): 564570.
Schulz, C., Engel, U. et al. (2007). "Vitamin A and beta-carotene supply of women with gemini or
short birth intervals - A pilot study." European Journal of Nutrition 46: 12-20.
Schweigert, F. J., Bathe, K. et al. (2004). "Effect of the stage of lactation in humans on carotenoid
levels in milk, blood plasma and plasma lipoprotein fractions." European Journal of Nutrition
43(1): 39-44.
Schweigert, F., Raila, J. et al. (2011). "Point of care measurements of Vitamin A in blood and breast
milk for low resource settings." Annals of Nutrition and Metabolism 58: 382.
Song, B. J., Jouni, Z. E. et al. (2013). "Assessment of phytochemical concentration in human milk
during different stages of lactation." Nutrition 29(1): 195-202.
Szlagatys-Sidorkiewicz, A., Zagierski, M. et al. (2012). "Longitudinal study of vitamins A, E and lipid
oxidative damage in human milk throughout lactation." Early Human Development 88(6): 421-424.
Tacken, K. J. M., Vogelsang, A. et al. (2009). "Loss of triglycerides and carotenoids in human milk
after processing." Archives of Disease in Childhood: Fetal and Neonatal Edition 94(6): F447-F450.
EFSA supporting publication 2014:EN-629
107
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively
by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender
procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be
considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the
issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Tijerina-Saenz, A., Innis, S. M. et al. (2009). "Antioxidant capacity of human milk and its association
with vitamins A and e and fatty acid composition." Acta Paediatrica, International Journal of
Paediatrics 98(11): 1793-1798.
Tokusoglu, O., Tansug, N. et al. (2008). "Retinol and (alpha)-tocopherol concentrations in breast milk
of Turkish lactating mothers under different socio-economic status." International Journal of Food
Sciences and Nutrition 59(2): 166-174.
Vahamiko, S., Isolauri, E. et al. (2013). "The impact of dietary counselling during pregnancy on
vitamin intake and status of women and their children." International Journal of Food Sciences and
Nutrition 64(5): 638-647.
Vitamin B1
Hampel, D., York, E. R. et al. (2012). "Ultra-performance liquid chromatography tandem massspectrometry (UPLC-MS/MS) for the rapid, simultaneous analysis of thiamin, riboflavin, flavin
adenine dinucleotide, nicotinamide and pyridoxal in human milk." Journal of Chromatography B:
Analytical Technologies in the Biomedical and Life Sciences 903: 7-13.
Ortega, R. M., Martinez, R. M. et al. (2004). "Thiamin status during the third trimester of pregnancy
and its influence on thiamin concentrations in transition and mature breast milk." British Journal of
Nutrition 92(1): 129-135.
Copper
Bjorklund, K. L., Vahter, M. et al. (2012). "Metals and trace element concentrations in breast milk of
first time healthy mothers: A biological monitoring study." Environmental Health: A Global
Access Science Source 11(1): 92.
Orun, E., Songul Yalcin, S. et al. (2012). "Zinc and copper concentrations in breastmilk at the second
month of lactation." Indian Pediatrics 49(2): 133-135.
Winiarska-Mieczan, A. (2014). "Cadmium, Lead, Copper and Zinc in Breast Milk in Poland." Biol
Trace Elem Res 157: 36-44.
Chloride
Bauer, J. and Gerss, J. (2011). "Longitudinal analysis of macronutrients and minerals in human milk
produced by mothers of preterm infants." Clinical Nutrition 30(2): 215-220.
Magnesium
Bauer, J. and Gerss, J. (2011). "Longitudinal analysis of macronutrients and minerals in human milk
produced by mothers of preterm infants." Clinical Nutrition 30(2): 215-220.
EFSA supporting publication 2014:EN-629
108
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively
by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender
procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be
considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the
issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Bjorklund, K. L., Vahter, M. et al. (2012). "Metals and trace element concentrations in breast milk of
first time healthy mothers: A biological monitoring study." Environmental Health: A Global
Access Science Source 11(1): 92.
Witczak, A. and Jarnuszewska, A. (2011). "[The concentration of selected mineral nutrients in infant
and follow-on formulae available at retail stores in Szczecin]." Roczn. Pzh 62(3): 257-262.
Sodium
Bauer, J. and Gerss, J. (2011). "Longitudinal analysis of macronutrients and minerals in human milk
produced by mothers of preterm infants." Clinical Nutrition 30(2): 215-220.
Bjorklund, K. L., Vahter, M. et al. (2012). "Metals and trace element concentrations in breast milk of
first time healthy mothers: A biological monitoring study." Environmental Health: A Global
Access Science Source 11(1): 92.
Campbell-Yeo, M. L., Allen, A. C. et al. (2010). "Effect of domperidone on the composition of
preterm human breast milk." Pediatrics 125(1): e107-e114.
Galipeau, R., Goulet, C. et al. (2012). "Infant and maternal factors influencing breastmilk sodium
among primiparous mothers." Breastfeeding Medicine 7(4): 290-294.
Gulson, B. L., Mizon, K. J. et al. (2001). "Dietary intakes of selected elements from longitudinal 6-day
duplicate diets for pregnant and nonpregnant subjects and elemental concentrations of breast milk
and infant formula." Environmental Research 87(3): 160-174.
Kumral, A., Duman, N. et al. (2002). "Hypernatraemic dehydration due to high sodium concentrations
in breast milk: Possible relationship with unwanted pregnancy [1]." Acta Paediatrica, International
Journal of Paediatrics 91(11): 1268-1269.
Manganaro, R., Marseglia, L. et al. (2007). "Breast milk sodium concentration, sodium intake and
weight loss in breast-feeding newborn infants." British Journal of Nutrition 97(2): 344-348.
Orgun, L. T., Atlihan, F. et al. (2010). "Evaluation of breast milk sodium and neonatal hypernatremic
dehydration." Early Human Development 86: S146.
Ozbek, A., Kumral, A. et al. (2008). "Maternal psychosocial aspects in hypernatremic dehydration
with high sodium concentrations in breast milk: A case-control study." Journal of Paediatrics and
Child Health 44(1-2): 38-43.
Powe, C. E., Puopolo, K. M. et al. (2011). "Effects of recombinant human prolactin on breast milk
composition." Pediatrics 127(2): e359-e366.
Savilahti, E. and Saarinen, K. M. (2007). "Colostrum TGF-(beta)-1 associates with the duration of
breast-feeding." European Journal of Nutrition 46(4): 238-242.
Tarcan, A., Tiker, F. et al. (2005). "Weight loss and hypernatremia in breast-fed babies: Frequency in
neonates with non-hemolytic jaundice." Journal of Paediatrics and Child Health 41(9-10): 484-487.
EFSA supporting publication 2014:EN-629
109
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively
by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender
procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be
considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the
issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
APPENDICES
A. SEARCH STRATEGIES FOR FOLATES
1.
Search strategies on Pubmed
Search strategy
Pubmed
1
“Folic Acid”[MeSH] OR “Folic Acid” OR “Folate”[MeSH] OR “Folates”[MeSH]
OR folate OR folates OR “Vitamin B9” OR “Vitamin B 9” OR “Vitamin B-9” OR
“Vitamin B(9)”
47 470
2
"Milk, Human"[Mesh] OR "Milk, Human" OR “human milk” OR "breast milk" OR
breast milk OR “breast feeding”[MeSH] OR “breast feeding” OR “women milk” OR
“women’s milk” OR “mother’s milk”
44 002
3
1 AND 2
341
4
3 Limit 2000/01/01
161
5
4 “NOT (Animals NOT Humans)”
161
Date of search: 9th of December 2013
2.
Search strategies on Embase
Search strategy
Embase
1
“Folic Acid”[emtree] OR “Folic Acid” OR “Folate”[emtree] OR “Folates”[emtree]
OR folate OR folates OR “Vitamin B9” OR “Vitamin B 9” OR “Vitamin B-9” OR
“Vitamin B(9)”
203896
2
"breast milk"[emtree] OR "breast feeding"[emtree] OR “lactation” [emtree] OR
breast milk OR “women milk” OR “women’s milk” OR “mother’s milk”
80706
3
1 AND 2
1244
4
#3 Limit 2000/01/01
951
5
#4 Limit to Embase
890
6
#5 not (animal not human) [Limit to human]
836
Date of search: 6th of December 2013
EFSA supporting publication 2014:EN-629
110
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively
by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender
procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be
considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the
issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
3.
Search strategies on Web of Science
Search strategy
Web Of
Science
1
“Folic Acid” OR “Vitamin M” OR ”Pteroylglutamic Acid” OR ”Vitamin B9” OR
”B9, Vitamin” OR “Vitamin B 9” OR “Vitamin B-9” OR “Vitamin B(9)” OR
”Folate” OR ”Folic Acid, (D)-Isomer” OR ”Folic Acid, (DL)-Isomer” OR ”Folic
Acid, Calcium Salt (1:1)” OR ”Folic Acid, Monosodium Salt” OR ”Folic Acid,
Potassium Salt” OR ”Folic Acid, Sodium Salt” OR ”Folvite” OR ”Folacin” OR
”Folic Acid, Monopotassium Salt” OR “folate*” OR “Vitamin M” OR
“Pteroylglutamic Acid” OR “Vitamin B9” OR “B9, Vitamin” OR “Folate” OR
“Folic Acid, (D)-Isomer” OR “Folic Acid, (DL)-Isomer” OR “Folic Acid, Calcium
Salt (1:1)” OR “Folic Acid, Monosodium Salt” OR “Folic Acid, Potassium Salt” OR
“Folic Acid, Sodium Salt” OR “Folvite” OR “Folacin” OR “Folic Acid,
Monopotassium Salt” OR "Folic Acid"[All Fields] OR ("folic" AND "acid") OR
"folic acid" OR "folates" OR "Vitamin B9" OR "Vitamin B 9" OR "Vitamin B-9"
OR "Vitamin B(9)"
34 278
2
"Milk, Human" OR “Breast Milk” OR “Breast Milks” OR “Milk, Breast” OR
“human milk” OR “Breast milk” OR “Feeding, Breast” OR “Breastfeeding” OR
“Breast Feeding, Exclusive” OR “Exclusive Breast Feeding” OR “Breastfeeding,
Exclusive” OR “Exclusive Breastfeeding” OR “breast feeding” OR “women milk”
OR “women’s milk” OR “mother’s milk”
32 276
3
1 AND 2
267
4
3 Limit 2000/01/01
172
5
4 “NOT (Animals NOT Humans)”
172
Date of search: 10th of December 2013
4.
Grey literature searches
Grey literature was searched by hand, using relevant keywords, more or less specific according to the
searched websites/databases (see the following table). Websites interface and structure were carefully
screened for identifying any relevant information.
EFSA supporting publication 2014:EN-629
111
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively
by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender
procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be
considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the
issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
URL
Access date
Search terms used
"breast milk folic acid" , "breast milk
folate", "breast milk folates"
https://www.google.com/
30.12.2013
"human milk folic acid" , "human milk
folate", "human milk folates"
"breast milk folic acid" , "breast milk
folate", "breast milk folates"
http://scholar.google.fr/
30.12.2013
"human milk folic acid" , "human milk
folate", "human milk folates"
"breast milk folic acid" , "breast milk
folate", "breast milk folates"
http://books.google.com/
30.12.2013
"human milk folic acid" , "human milk
folate", "human milk folates"
http://www.nrv.gov.au/
http://www.codexalimentariu
s.org/
30.12.2013
30.12.2013
Search by hand
Specific
features
Relevant
reference?
Reason for
exclusion
Period
searched
from 2000
http://www.
drugs.com/p
regnancy/fol
ic-acid.html
No reference
Period
searched
from 2000
No more
information
than that yet
retrieved
from the
databases
Period
searched
from 2000
Information
out of the
range of
selected
dates
Search in the
“Nutrients”
and
“Ressources
” section
Information
out of the
range of
selected
dates
"breast milk folic acid" , "breast milk
folate", "breast milk folates", “breast milk
nutrients” "human milk folic acid" ,
"human milk folate", "human milk folates"
“human milk nutrients”
No relevant
information
Search by hand in the reports
http://www.eurreca.org/ever
yone/
30.12.2013
Search by hand
http://www.nutrition.org/
30.12.2013
"breast milk folic acid" , "breast milk
folate", "breast milk folates"
"human milk folic acid" , "human milk
EFSA supporting publication 2014:EN-629
Search in the
“Scientific
Publication
section
No more
information
than that yet
retrieved
from the
databases
No more
information
than that yet
retrieved
112
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the
context of a contract between the European Food Safety Authority and the author(s), awarded following a tender procedure. The present document is published
complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European Food
Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the
rights of the authors.
Vitamin and mineral content of breast milk
URL
Access date
Search terms used
Specific
features
folate", "human milk folates"
Relevant
reference?
from the
databases
http://ndri.co
m/article/co
mposition_o
f_breast_mil
k_and_comp
arison_with_
cows_and_st
andard_form
ula_milk425.html
"breast milk folic acid" , "breast milk
folate", "breast milk folates"
http://scientific.thomsonweb
plus.com/
30.12.2013
http://clinicaltrials.gov/
30.12.2013
"breast milk”, “human milk” “folic acid”,
“folates"
No relevant
information
http://www.oclc.org/
30.12.2013
"breast milk”, “human milk” “folic acid”,
“folates"
No relevant
information
http://www.opengrey.eu/
30.12.2013
"breast milk”, “human milk” “folic acid”,
“folates"
No relevant
information
http://www.efsa.europa.eu/
"human milk folic acid" , "human milk
folate", "human milk folates"
30.12.2013
Reason for
exclusion
"breast milk”, “human milk” “folic acid”,
“folates"
No reference
No relevant
information
Search by hand in the reports
"breast milk”, “human milk” “folic acid”,
“folates"
http://www.anses.fr/
30.12.2013
“lait maternel”, “acide folique”, “folates”
French and
English
searches
No relevant
information
Advanced
search with
restriction to
articles
published
from 2000
No relevant
information
Search by hand in the reports
"breast milk folic acid" , "breast milk
folate", "breast milk folates"
http://www.jstor.org/
30.12.2013
"human milk folic acid" , "human milk
folate", "human milk folates"
http://www.greylit.org/
30.12.2013
EFSA supporting publication 2014:EN-629
"breast milk folic acid" , "breast milk
No relevant
113
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the
context of a contract between the European Food Safety Authority and the author(s), awarded following a tender procedure. The present document is published
complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European Food
Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the
rights of the authors.
Vitamin and mineral content of breast milk
URL
Access date
Search terms used
Specific
features
folate", "breast milk folates"
Relevant
reference?
Reason for
exclusion
information
"human milk folic acid" , "human milk
folate", "human milk folates"
"breast milk folic acid" , "breast milk
folate", "breast milk folates"
http://worldwidescience.org/
No relevant
information
30.12.2013
"human milk folic acid" , "human milk
folate", "human milk folates"
"breast milk folic acid" , "breast milk
folate", "breast milk folates"
http://www.science.gov/
No relevant
information
30.12.2013
"human milk folic acid" , "human milk
folate", "human milk folates"
http://www.collectionscanad
a.gc.ca/thesescanada/
30.12.2013
"breast milk”, “human milk” “folic acid”,
“folates"
“lait maternel”, “acide folique”, “folates”
"breast milk folic acid" , "breast milk
folate", "breast milk folates"
http://trove.nla.gov.au/
30.12.2013
"human milk folic acid" , "human milk
folate", "human milk folates"
French and
English
searches
No relevant
information
Advanced
search with
restriction to
articles
published
from 2000
No relevant
information
"breast milk folic acid" , "breast milk
folate", "breast milk folates"
http://scienceresearch.com/
No relevant
information
30.12.2013
"human milk folic acid" , "human milk
folate", "human milk folates"
http://www.sudoc.abes.fr/
30.12.2013
"breast milk”, “human milk” “folic acid”,
“folates"
“lait maternel”, “acide folique”, “folates”
https://www.google.pl/
31.12.2013
EFSA supporting publication 2014:EN-629
"breast/human milk folic acid" ,
"breast/human milk folate", “breast/human
milk nutrients”, “breast/human milk
composition” – in Polish language
French and
English
searches
No relevant
information
Period
searched
from 2000;
Polish
No more
information
than that yet
retrieved
from the
114
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the
context of a contract between the European Food Safety Authority and the author(s), awarded following a tender procedure. The present document is published
complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European Food
Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the
rights of the authors.
Vitamin and mineral content of breast milk
URL
http://scholar.google.pl/
http://books.google.com/?hl
=pl
http://www.ptzkd.org/
http://www.neonatologia.edu
.pl/
http://www.ptp.edu.pl/
http://www.izz.waw.pl/pl/
Specific
features
Relevant
reference?
searches
databases
3.01.2014
breast/human milk folic acid" ,
"breast/human milk folate", “breast/human
milk nutrients”, “breast/human milk
composition” – in Polish language
Period
searched
from 2000;
Polish
searches
No more
information
than that yet
retrieved
from the
databases
3.01.2014
breast/human milk folic acid" ,
"breast/human milk folate", “breast/human
milk nutrients”, “breast/human milk
composition” – in Polish language
Period
searched
from 2000;
Polish
searches
No relevant
information
3.01.2014
"breast/human milk folic acid" ,
"breast/human milk folate", “breast/human
milk nutrients”, “breast/human milk
composition” – in Polish language
Polish
searches
No relevant
information
3.01.2014
"breast/human milk folic acid" ,
"breast/human milk folate", “breast/human
milk nutrients”, “breast/human milk
composition” – in Polish language
Polish
searches
No relevant
information
3.01.2014
"breast/human milk folic acid" ,
"breast/human milk folate", “breast/human
milk nutrients”, “breast/human milk
composition” – in Polish language
Polish
searches
No relevant
information
3.01.2014
"breast/human milk folic acid" ,
"breast/human milk folate", “breast/human
milk nutrients”, “breast/human milk
composition” – in Polish language
Polish
searches
No relevant
information
Access date
EFSA supporting publication 2014:EN-629
Search terms used
Reason for
exclusion
115
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the
context of a contract between the European Food Safety Authority and the author(s), awarded following a tender procedure. The present document is published
complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European Food
Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the
rights of the authors.
Vitamin and mineral content of breast milk
B. SEARCH STRATEGIES FOR ZINC
1.
Search strategies on Pubmed
Search strategy
Pubmed
1
“Zinc”[MeSH] OR Zinc
104 762
2
"Milk, Human"[Mesh] OR "Milk, Human" OR “human milk” OR "breast milk" OR
breast milk OR “breast feeding”[MeSH] OR “breast feeding” OR “women milk” OR
“women’s milk” OR “mother’s milk”
44 163
3
1 AND 2
728
4
3 Limit 2000/01/01
305
5
4 “NOT (Animals NOT Humans)”
300
Date of search: 3rd of January 2014
2.
Search strategies on Embase
Search strategy
Embase
1
Zinc”[emtree] OR Zinc
161584
2
"breast milk"[emtree] OR "breast feeding"[emtree] OR “lactation” [emtree] OR
breast milk OR “women milk” OR “women’s milk” OR “mother’s milk”
80834
3
1 AND 2
1468
4
#3 Limit 2000/01/01
875
5
#4 Limit to Embase
782
6
#5 not (animal not human) [Limit to human]
665
Date of search: 7th of January 2014
EFSA supporting publication 2014:EN-629
116
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively
by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender
procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be
considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the
issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
3.
Search strategies on Web of Science
Web Of
Science
Search strategy
1
Topic=(zinc)
227 305
2
Topic=(“Milk, Human" OR “Breast Milk” OR “Breast Milks” OR “Milk, Breast”
OR “human milk” OR “Breast milk” OR “Feeding, Breast” OR “Breastfeeding” OR
“Breast Feeding, Exclusive” OR “Exclusive Breast Feeding” OR “Breastfeeding,
Exclusive” OR “Exclusive Breastfeeding” OR “breast feeding” OR “women milk”
OR “women’s milk” OR “mother’s milk”)
32 991
3
1 AND 2
744
4
3 Timespan=2000-2014
457
5
4 “NOT (Animals NOT Humans)”
445
Date of search: 3rd of January 2014
4.
Grey literature searches
Grey literature was searched by hand, using relevant keywords, more or less specific according to the
searched websites/databases (see the following table). Websites interface and structure were carefully
screened for identifying any relevant information.
URL
Access date
Search terms
used
"breast milk
zinc" , "breast
milk zinc",
"breast milk
zinc"
https://www.go
ogle.com/
11.02.2014
http://scholar.go
ogle.fr/
11.02.2014
"human milk
zinc" , "human
milk zinc",
"human milk
zinc"
"breast milk
zinc" , "breast
milk zinc",
EFSA supporting publication 2014:EN-629
Specific
features
Relevant
reference?
Period searched
from 2000
No more
information
than that yet
retrieved from
the databases
Period searched
from 2000
Reason for
exclusion
No more
information
than that yet
117
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively
by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender
procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be
considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the
issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
URL
Access date
Search terms
used
Specific
features
"breast milk
zinc"
Relevant
reference?
Reason for
exclusion
retrieved from
the databases
"human milk
zinc" , "human
milk zinc",
"human milk
zinc"
http://books.goo
gle.com/
http://www.nrv.
gov.au/
http://www.cod
exalimentarius.
org/
"breast milk
zinc" , "breast
milk zinc",
"breast milk
zinc"
11.02.2014
"human milk
zinc" , "human
milk zinc",
"human milk
zinc"
11.02.2014
11.02.2014
Search by hand
Period searched
from 2000
Information out
of the range of
selected dates
Search in the
“Nutrients” and
“Ressources”
section
Information out
of the range of
selected dates
"breast milk
zinc" , "breast
milk zinc",
"breast milk
zinc", “breast
milk nutrients”
"human milk
zinc" , "human
milk zinc",
"human milk
zinc" “human
milk nutrients”
No relevant
information
Search by hand
in the reports
http://www.eurr
eca.org/everyon
e/
11.02.2014
Search by hand
EFSA supporting publication 2014:EN-629
Search in the
“Scientific
Publication
section
No more
information
than that yet
retrieved from
the databases
118
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively
by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender
procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be
considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the
issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
URL
http://www.nutr
ition.org/
Access date
Search terms
used
Specific
features
"breast milk
zinc" , "breast
milk zinc",
"breast milk
zinc"
Relevant
reference?
No more
information
than that yet
retrieved from
the databases
11.02.2014
"human milk
zinc" , "human
milk zinc",
"human milk
zinc"
"breast milk
zinc" , "breast
milk zinc",
"breast milk
zinc"
No more
information
than that yet
retrieved from
the databases
http://scientific.t
homsonwebplus
.com/
11.02.2014
http://clinicaltri
als.gov/
11.02.2014
"breast milk”,
“human milk”
“zinc”, “zinc"
No relevant
information
http://www.oclc
.org/
11.02.2014
"breast milk”,
“human milk”
“zinc”, “zinc"
No relevant
information
http://www.ope
ngrey.eu/
11.02.2014
"breast milk”,
“human milk”
“zinc”, “zinc"
No relevant
information
http://www.efsa
.europa.eu/
"human milk
zinc" , "human
milk zinc",
"human milk
zinc"
11.02.2014
Reason for
exclusion
"breast milk”,
“human milk”
“zinc”, “zinc"
No relevant
information
Search by hand
in the reports
http://www.anse
s.fr/
11.02.2014
"breast milk”,
“human milk”
EFSA supporting publication 2014:EN-629
French and
English
No relevant
information
119
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively
by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender
procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be
considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the
issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
URL
Access date
Search terms
used
Specific
features
“zinc”, “zinc"
searches
Relevant
reference?
Reason for
exclusion
“lait maternel”,
“zinc”, “zinc”
Search by hand
in the reports
http://www.jstor
.org/
http://www.grey
lit.org/
"breast milk
zinc" , "breast
milk zinc",
"breast milk
zinc"
11.02.2014
"human milk
zinc" , "human
milk zinc",
"human milk
zinc"
"breast milk
zinc" , "breast
milk zinc",
"breast milk
zinc"
11.02.2014
"human milk
zinc" , "human
milk zinc",
"human milk
zinc"
"breast milk
zinc" , "breast
milk zinc",
"breast milk
zinc"
http://worldwid
escience.org/
11.02.2014
http://www.scie
nce.gov/
12.02.2014
"human milk
zinc" , "human
milk zinc",
"human milk
zinc"
"breast milk
zinc" , "breast
milk zinc",
"breast milk
EFSA supporting publication 2014:EN-629
Advanced
search with
restriction to
articles
published from
2000
No relevant
information
No relevant
information
No relevant
information
No relevant
information
120
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively
by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender
procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be
considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the
issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
URL
Access date
Search terms
used
Specific
features
Relevant
reference?
French and
English
searches
No relevant
information
Advanced
search with
restriction to
articles
published from
2000
No relevant
information
Reason for
exclusion
zinc"
"human milk
zinc" , "human
milk zinc",
"human milk
zinc"
http://www.coll
ectionscanada.g
c.ca/thesescana
da/
http://trove.nla.
gov.au/
http://scienceres
earch.com/
http://www.sud
oc.abes.fr/
12.02.2014
"breast milk”,
“human milk”
“zinc”, “zinc"
“lait maternel”,
“zinc”, “zinc”
"breast milk
zinc" , "breast
milk zinc",
"breast milk
zinc"
12.02.2014
"human milk
zinc" , "human
milk zinc",
"human milk
zinc"
"breast milk
zinc" , "breast
milk zinc",
"breast milk
zinc"
No relevant
information
12.02.2014
"human milk
zinc" , "human
milk zinc",
"human milk
zinc"
12.02.2014
"breast milk”,
“human milk”
“zinc”, “zinc"
“lait maternel”,
“zinc”, “zinc”
EFSA supporting publication 2014:EN-629
French and
English
searches
No relevant
information
121
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively
by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender
procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be
considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the
issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
URL
https://www.go
ogle.pl/
http://scholar.go
ogle.pl/
http://books.goo
gle.com/?hl=pl
http://www.ptzk
d.org/
http://www.neo
natologia.edu.pl
/
Access date
Search terms
used
Specific
features
Relevant
reference?
"breast/human
milk zinc"
,“breast/human
milk nutrients”,
“breast/human
milk
composition” –
in Polish
language
Period searched
from 2000;
Polish searches
06.02.2014
“breast/human
milk zinc",
“breast/human
milk nutrients”,
“breast/human
milk
composition” –
in Polish
language
Period searched
from 2000;
Polish searches
No more
information
than that yet
retrieved from
the databases
06.02.2014
“breast/human
milk zinc",
“breast/human
milk nutrients”,
“breast/human
milk
composition” –
in Polish
language
Period searched
from 2000;
Polish searches
No relevant
information
06.02.2014
"breast/human
milk zinc",
“breast/human
milk nutrients”,
“breast/human
milk
composition” –
in Polish
language
Polish searches
No relevant
information
Polish searches
No relevant
information
06.02.2014
06.02.2014
"breast/human
milk zinc",
“breast/human
milk nutrients”,
“breast/human
milk
EFSA supporting publication 2014:EN-629
No relevant
information or
no more
information
than that yet
retrieved from
the databases
Reason for
exclusion
1 secondary
publication:
Pawlus 2004
1 publication
with data on
other nutrients:
Stasiuk 2012
1 duplicate:
PiotrowskaDepta 2006
122
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively
by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender
procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be
considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the
issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
URL
Specific
features
Relevant
reference?
06.02.2014
"breast/human
milk zinc",
“breast/human
milk nutrients”,
“breast/human
milk
composition” –
in Polish
language
Polish searches
No relevant
information
06.02.2014
"breast/human
milk zinc",
“breast/human
milk nutrients”,
“breast/human
milk
composition” –
in Polish
language
Polish searches
No relevant
information
Access date
Search terms
used
Reason for
exclusion
composition” –
in Polish
language
http://www.ptp.
edu.pl/
http://www.izz.
waw.pl/pl/
EFSA supporting publication 2014:EN-629
123
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively
by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender
procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be
considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the
issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
C. SEARCH STRATEGIES FOR VITAMIN B6, VITAMIN E, CHOLINE, PHOSPHORUS AND POTASSIUM
1.
Search strategies on Pubmed
Search strategy
PubMed
1
“Vitamin E”[MeSH] OR “Vitamin E” OR “tocopherol”[MeSH] OR “tocopherol*”
OR “tocotrienol”[MeSH] OR “tocotrienol*” OR “Choline”[MeSH] OR “Choline”
OR “Vitamin B6”[MeSH] OR “Vitamin B6” OR “Vitamin B 6” OR “Vitamin B-6”
OR “Vitamin B(6)” OR "pyridoxal phosphate”[MeSH] OR "Phosphorus,
Dietary"[Mesh] OR “Phosphorus”[MeSH] OR “Phosphorus”
195 780
2
1 Limit 2000/01/01
70 597
3
“Potassium, Dietary” [MeSH] OR Potassium [MeSH] OR Potassium
222 067
4
3 Limit 2010/10/01
18 529
5
2 OR 4
88 356
6
"Milk, Human"[Mesh] OR "Milk, Human" OR “human milk” OR "breast milk" OR
breast milk OR “breast feeding”[MeSH] OR “breast feeding” OR “women milk” OR
“women’s milk” OR “mother’s milk”
44 163
7
5 AND 6
244
8
7 “NOT (Animals NOT Humans)”
237
Date of search: 3rd of January 2014
2.
Search strategies on Embase
Search strategy
Embase
1
“Vitamin E”[emtree] OR “Vitamin E“ OR “tocopherol”[emtree] OR tocopherol* OR
“tocotrienol”[emtree] OR tocotrienol* OR “Choline”[emtree] OR Choline OR
“Vitamin B6”[emtree] OR “Vitamin B6” OR “Vitamin B 6” OR “Vitamin B-6” OR
“Vitamin B(6)” OR "pyridoxal phosphate”[emtree] OR pyridoxine [emtree] OR
"Phosphorus, Dietary"[emtree] OR “Phosphorus”[emtree] OR Phosphorus
528194
2
"breast milk"[emtree] OR "breast feeding"[emtree] OR “lactation” [emtree] OR
breast milk OR “women milk” OR “women’s milk” OR “mother’s milk”
80834
EFSA supporting publication 2014:EN-629
124
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively
by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender
procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be
considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the
issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Search strategy
Embase
3
1 AND 2
2410
4
#3 Limit 2000/01/01
1254
5
#4 Limit to Embase
1041
6
"Potassium"[emtree] OR “potassium ion” [emtree] OR “potassium”
329193
7
2 AND 6
939
8
#7 Limit 2010/10/01
141
9
#8 Limit to Embase
127
10
5 OR 9
1144
11
#10 not (animal not human) [Limit to human]
936
Date of search: 7th of January 2014
3.
Search strategies on Web of Science
Search strategy
1
Topic=(“Vitamin E” OR “tocopherol” OR “tocopherol*” OR “Abortosan” OR
“Aquasol E” OR “Auxina E Bio E” OR “Biopto-E” OR “Biosan” OR “Lasar” OR
“Bioweyxin” OR “Davitamon” OR “Dermorelle” OR “Detulin” OR “E-ferol” OR “E
ferol” OR “E-Mulsin” OR “E Mulsin” OR “E-Vicotrat” OR “E Vicotrat” OR “EVitamin-ratiopharm” OR “Ecoro” OR “Elex Verla” OR “Embial” OR “Evion” OR
“Ephynal” OR “Eplonat” OR “Equivit E” OR “Antioxidans E-Hevert” OR “Eusovit”
OR “Hydrovit E” OR “Micorvit E” OR “Malton E” OR “Vitazell” OR “Puncto E”
OR “Richtavit E” OR “Sanavitan S” OR “Snow-E Muscle, Energy and Fertility” OR
“Spondyvit” OR “Tocolion” OR “Tocopa” OR “Tocopharm” OR “Vibolex” OR “Vit
E hydrosol” OR “Vitamin E Stada” OR “Vita-E” OR “Vita E” OR “VitaE” OR
“Tocovital” OR “Unique E” OR “Uno-Vit” OR “Uno Vit” OR “UnoVit” OR “VitaPlus E” OR “Vita Plus E” OR “VitaPlus E” OR “Vitamin-E Dragees” OR “Dragees,
Vitamin-E” OR “Vitamin-E EVI-MIRALE” OR “EVI-MIRALE, Vitamin-E” OR
“Vitamine E GNR” OR “Dal-E” OR “Dal E” OR “tocotrienol” OR “tocotrienol*”
OR “Choline” OR “2-Hydroxy-N,N,N-trimethylethanaminium” OR “Choline
Citrate” OR “Citrate, Choline” OR “Choline Bitartrate” OR “Bitartrate, Choline” OR
EFSA supporting publication 2014:EN-629
Web Of
Science
149 755
125
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively
by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender
procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be
considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the
issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Search strategy
Web Of
Science
“Bursine” OR “Vidine” OR “Choline Hydroxide” OR “Hydroxide, Choline” OR
“Fagine” OR “Choline Chloride” OR “Chloride, Choline” OR “Choline O-Sulfate”
OR “Choline O Sulfate” OR “O-Sulfate, Choline” OR “Vitamin B6” OR “Vitamin B
6” OR “Vitamin B-6” OR “Vitamin B(6)” OR "pyridoxal phosphate” OR
“Phosphate, Pyridoxal” OR “Pyridoxal-P” OR “Pyridoxal P” OR “Pyridoxal 5Phosphate” OR “Pyridoxal 5 Phosphate” OR "Phosphorus, Dietary" OR “Dietary
Phosphorus” OR “Phosphorus”)
2
1 Timespan=(2000-2014)
83 217
3
Topic=(“Potassium, Dietary” OR “Dietary Potassium” OR “Potassium” OR
“Potassium Ion Level” OR “Ion Level, Potassium” OR “Level, Potassium Ion”)
205 835
4
3 Timespan=(2010.10.01-2014)
33 506
5
2 OR 4
114 129
6
Topic=(“Milk, Human" OR “Breast Milk” OR “Breast Milks” OR “Milk, Breast”
OR “human milk” OR “Breast milk” OR “Feeding, Breast” OR “Breastfeeding” OR
“Breast Feeding, Exclusive” OR “Exclusive Breast Feeding” OR “Breastfeeding,
Exclusive” OR “Exclusive Breastfeeding” OR “breast feeding” OR “women milk”
OR “women’s milk” OR “mother’s milk”)
32 991
7
5 AND 6
121
8
7 “NOT (Animals NOT Humans)”
121
Date of search: 3rd of January 2014
4.
Grey literature searches
Grey literature was searched by hand, using relevant keywords, more or less specific according to the
searched websites/databases (see the following table). Websites interface and structure were carefully
screened for identifying any relevant information.
EFSA supporting publication 2014:EN-629
126
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively
by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender
procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be
considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the
issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
URL
https://www.go
ogle.com/
http://scholar.go
ogle.fr/
http://books.goo
gle.com/
http://www.nrv.
gov.au/
Access date
Search terms used
"breast milk spec
micronutrient" ,
"breast milk spec
micronutrient",
"breast milk spec
micronutrient"
17.02.2014
"human milk spec
micronutrient" ,
"human milk spec
micronutrient",
"human milk spec
micronutrient"
"breast milk spec
micronutrient" ,
"breast milk spec
micronutrient",
"breast milk spec
micronutrient"
17.02.2014
"human milk spec
micronutrient" ,
"human milk spec
micronutrient",
"human milk spec
micronutrient"
"breast milk spec
micronutrient" ,
"breast milk spec
micronutrient",
"breast milk spec
micronutrient"
17.02.2014
"human milk spec
micronutrient" ,
"human milk spec
micronutrient",
"human milk spec
micronutrient"
17.02.2014
Search by hand
EFSA supporting publication 2014:EN-629
Specific
features
Relevant
reference?
Period searched
from 2000
No more
information
than that yet
retrieved from
the databases
Period searched
from 2000
No more
information
than that yet
retrieved from
the databases
Period searched
from 2000
Information out
of the range of
selected dates
Search in the
“Nutrients” and
“Ressources”
section
Information out
of the range of
selected dates
Reason for
exclusion
127
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively
by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender
procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be
considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the
issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
URL
http://www.cod
exalimentarius.
org/
Access date
17.02.2014
Search terms used
Specific
features
"breast milk spec
micronutrient" ,
"breast milk spec
micronutrient",
"breast milk spec
micronutrient",
“breast milk
nutrients” "human
milk spec
micronutrient" ,
"human milk spec
micronutrient",
"human milk spec
micronutrient"
“human milk
nutrients”
Relevant
reference?
Reason for
exclusion
No relevant
information
Search by hand in
the reports
http://www.eurr
eca.org/everyon
e/
http://www.nutr
ition.org/
http://scientific.t
homsonwebplus
.com/
17.02.2014
Search by hand
"breast milk spec
micronutrient" ,
"breast milk spec
micronutrient",
"breast milk spec
micronutrient"
17.02.2014
"human milk spec
micronutrient" ,
"human milk spec
micronutrient",
"human milk spec
micronutrient"
17.02.2014
"breast milk spec
micronutrient" ,
"breast milk spec
micronutrient",
"breast milk spec
micronutrient"
Search in the
“Scientific
Publication
section
No more
information
than that yet
retrieved from
the databases
No more
information
than that yet
retrieved from
the databases
No more
information
than that yet
retrieved from
the databases
"human milk spec
micronutrient" ,
"human milk spec
EFSA supporting publication 2014:EN-629
128
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively
by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender
procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be
considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the
issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
URL
Access date
Search terms used
Specific
features
Relevant
reference?
Reason for
exclusion
micronutrient",
"human milk spec
micronutrient"
http://clinicaltri
als.gov/
http://www.oclc
.org/
http://www.ope
ngrey.eu/
http://www.efsa
.europa.eu/
17.02.2014
"breast milk”,
“human milk”
“spec
micronutrient”,
“spec
micronutrient"
No relevant
information
17.02.2014
"breast milk”,
“human milk”
“spec
micronutrient”,
“spec
micronutrient"
No relevant
information
17.02.2014
"breast milk”,
“human milk”
“spec
micronutrient”,
“spec
micronutrient"
No relevant
information
17.02.2014
"breast milk”,
“human milk”
“spec
micronutrient”,
“spec
micronutrient"
No relevant
information
Search by hand in
the reports
http://www.anse
s.fr/
17.02.2014
"breast milk”,
“human milk”
“spec
micronutrient”,
“spec
micronutrient"
French and
English
searches
No relevant
information
“lait maternel”,
“spec
micronutrient”,
“spec
EFSA supporting publication 2014:EN-629
129
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively
by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender
procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be
considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the
issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
URL
Access date
Search terms used
Specific
features
Relevant
reference?
Advanced
search with
restriction to
articles
published from
2000
No relevant
information
Reason for
exclusion
micronutrient”
Search by hand in
the reports
http://www.jstor
.org/
http://www.grey
lit.org/
http://worldwid
escience.org/
"breast milk spec
micronutrient" ,
"breast milk spec
micronutrient",
"breast milk spec
micronutrient"
17.02.2014
"human milk spec
micronutrient" ,
"human milk spec
micronutrient",
"human milk spec
micronutrient"
"breast milk spec
micronutrient" ,
"breast milk spec
micronutrient",
"breast milk spec
micronutrient"
17.02.2014
"human milk spec
micronutrient" ,
"human milk spec
micronutrient",
"human milk spec
micronutrient"
"breast milk spec
micronutrient" ,
"breast milk spec
micronutrient",
"breast milk spec
micronutrient"
17.02.2014
"human milk spec
micronutrient" ,
"human milk spec
micronutrient",
"human milk spec
micronutrient"
EFSA supporting publication 2014:EN-629
No relevant
information
No relevant
information
130
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively
by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender
procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be
considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the
issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
URL
http://www.scie
nce.gov/
http://www.coll
ectionscanada.g
c.ca/thesescana
da/
http://trove.nla.
gov.au/
http://scienceres
earch.com/
Access date
Search terms used
Specific
features
"breast milk spec
micronutrient" ,
"breast milk spec
micronutrient",
"breast milk spec
micronutrient"
"human milk spec
micronutrient" ,
"human milk spec
micronutrient",
"human milk spec
micronutrient"
17.02.2014
“lait maternel”,
“spec
micronutrient”,
“spec
micronutrient”
"breast milk spec
micronutrient" ,
"breast milk spec
micronutrient",
"breast milk spec
micronutrient"
17.02.2014
"human milk spec
micronutrient" ,
"human milk spec
micronutrient",
"human milk spec
micronutrient"
17.02.2014
"breast milk spec
micronutrient" ,
"breast milk spec
micronutrient",
"breast milk spec
micronutrient"
Reason for
exclusion
No relevant
information
17.02.2014
"breast milk”,
“human milk”
“spec
micronutrient”,
“spec
micronutrient"
Relevant
reference?
French and
English
searches
No relevant
information
Advanced
search with
restriction to
articles
published from
2000
No relevant
information
No relevant
information
"human milk spec
micronutrient" ,
EFSA supporting publication 2014:EN-629
131
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively
by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender
procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be
considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the
issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
URL
Access date
Search terms used
Specific
features
Relevant
reference?
French and
English
searches
No relevant
information
Reason for
exclusion
"human milk spec
micronutrient",
"human milk spec
micronutrient"
http://www.sud
oc.abes.fr/
17.02.2014
"breast milk”,
“human milk”
“spec
micronutrient”,
“spec
micronutrient"
“lait maternel”,
“spec
micronutrient”,
“spec
micronutrient”
https://www.go
ogle.pl/
24.02.2014
http://scholar.go
ogle.pl/
24.02.2014
http://books.goo
gle.com/?hl=pl
24.02.2014
"breast milk
vitamin B6",
“breast milk
choline”, “breast
milk vitamin E”,
“breast milk
potassium”, “breast
milk phosphorus”,
“breast milk
nutrients”, “breast
milk composition”
– in Polish
language
Period searched
from 2000 (vit
B6, vit E,
choline, P) and
2010 (K),
Polish searches
"breast milk
vitamin B6",
“breast milk
choline”, “breast
milk vitamin E”,
“breast milk
potassium”, “breast
milk phosphorus”,
“breast milk
nutrients”, “breast
milk composition”
– in Polish
language
Period searched
from 2000 (vit
B6, vit E,
choline, P) and
2010 (K),
Polish searches
"breast milk
vitamin B6",
“breast milk
Period searched
from 2000 (vit
B6, vit E,
EFSA supporting publication 2014:EN-629
1 secondary
publication:
Pawlus 2004
No more
information
than that yet
retrieved from
the databases
1 publication
with data on
other nutrients:
Stasiuk 2017
1 duplicate:
PiotrowskaDepta 2006
No relevant
information
No relevant
information
132
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively
by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender
procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be
considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the
issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
URL
Access date
Search terms used
choline”, “breast
milk vitamin E”,
“breast milk
potassium”, “breast
milk phosphorus”,
“breast milk
nutrients”, “breast
milk composition”
– in Polish
language
http://www.ptzk
d.org/
http://www.neo
natologia.edu.pl
/
http://www.ptp.
edu.pl/
Specific
features
Relevant
reference?
choline, P) and
2010 (K),
Polish searches
24.02.2014
"breast milk
vitamin B6",
“breast milk
choline”, “breast
milk vitamin E”,
“breast milk
potassium”, “breast
milk phosphorus”,
“breast milk
nutrients”, “breast
milk composition”
– in Polish
language
Polish searches
No relevant
information
06.02.2014
"breast milk
vitamin B6",
“breast milk
choline”, “breast
milk vitamin E”,
“breast milk
potassium”, “breast
milk phosphorus”,
“breast milk
nutrients”, “breast
milk composition”
– in Polish
language
Polish searches
No relevant
information
Polish searches
No relevant
information
24.02.2014
""breast milk
vitamin B6",
“breast milk
choline”, “breast
milk vitamin E”,
“breast milk
potassium”, “breast
milk phosphorus”,
“breast milk
nutrients”, “breast
milk composition”
EFSA supporting publication 2014:EN-629
Reason for
exclusion
133
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively
by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender
procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be
considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the
issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
URL
Access date
Search terms used
Specific
features
Relevant
reference?
Polish searches
No relevant
information
Reason for
exclusion
– in Polish
language
http://www.izz.
waw.pl/pl/
24.02.2014
"breast milk
vitamin B6",
“breast milk
choline”, “breast
milk vitamin E”,
“breast milk
potassium”, “breast
milk phosphorus”,
“breast milk
nutrients”, “breast
milk composition”
– in Polish
language
EFSA supporting publication 2014:EN-629
134
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively
by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender
procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be
considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the
issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
D. SEARCH STRATEGIES FOR VITAMIN A, VITAMIN B1, CHLORIDE, COPPER, MAGNESIUM AND
SODIUM
1.
Search strategies on Pubmed
Search strategy
PubMed
1
“Vitamin A”[MeSH] OR “Vitamin A” OR “retinol”[MeSH] OR “retinol” OR
“carotenoids”[MeSH] OR “carotenoid*” OR “retinoids”[MeSH] OR “retinoid*” OR
“Vitamin B1”[MeSH] OR “Vitamin B1” OR “thiamin”[MeSH] OR “thiamin” OR
“vitamin B1” OR “Vitamin B 1” OR “Vitamin B-1” OR “Vitamin B(1)” OR
“Chloride” OR “Chloride”[MeSH] OR “Sodium, Dietary”[MeSH] OR
“sodium”[MeSH] OR “Sodium” OR “electrolyte*”
690 819
2
1 Limit 2000/01/01
275 158
3
“Magnesium”[MeSH] OR “Magnesium”
89 951
4
3 Limit 2010/10/01
7 090
5
“Copper”[MeSH] OR “Copper”
91 634
6
5 Limit 2011/01/01
14 909
7
2 OR 4 OR 6
86 871
8
"Milk, Human"[Mesh] OR "Milk, Human" OR “human milk” OR "breast milk" OR
breastmilk OR “breast feeding”[MeSH] OR “breast feeding” OR “women milk” OR
“women’s milk” OR “mother’s milk”
44 165
9
7 AND 8
172
9 “NOT (Animals NOT Humans)”
165
10
th
Date of search 6 of January 2014
2.
Search strategies on Embase
Search strategy
Embase
1
“Vitamin A”[emtree] OR “Vitamin A” OR “retinol[emtree] OR retinol OR
“carotenoids”[ emtree] OR carotenoid* OR “retinoids”[ emtree] or retinoid* OR
“Vitamin B1”[emtree] OR Vitamin B1 OR “thiamin”[emtree] OR thiamin OR
“vitamin B1” OR “Vitamin B 1” OR “Vitamin B-1” OR “Vitamin B(1)” OR
Chloride OR “Chloride”[emtree] OR “Sodium, Dietary”[emtree] OR
“sodium”[emtree] OR Sodium OR electrolyte*
1266791
2
"breast milk"[emtree] OR "breast feeding"[emtree] OR “lactation” [emtree] OR
breastmilk OR “women milk” OR “women’s milk” OR “mother’s milk”
80834
3
1 AND 2
4979
EFSA supporting publication 2014:EN-629
135
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively
by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender
procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be
considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the
issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Search strategy
Embase
4
#3 Limit 2000/01/01
3054
5
#4 Limit to Embase
2733
6
"Copper"[emtree] OR “copper”
134112
7
2 AND 6
754
8
#7 Limit 2011/01/01
105
9
#8 Limit to Embase
93
10
"Magnesium"[emtree] OR “magnesium”
127805
11
2 AND 10
793
12
#11 Limit 2010/10/01
104
13
#12 Limit to Embase
94
14
5 OR 9 OR 13
2842
#14 not (animal not human) [Limit to human]
2308
15
th
Date of search 7 of January 2014
3.
Search strategies on Web of Science
Search strategy
Web Of
Science
1
Topic=(“Vitamin A” OR “Aquasol A” OR “Retinol” OR “3,7-dimethyl-9-(2,6,6trimethyl-1-cyclohexen-1-yl)-2,4,6,8-nonatetraen-1-ol, (all-E)-Isomer” OR “AllTrans-Retinol” OR “All Trans Retinol” OR “Vitamin A1” OR “11-cis-Retinol” OR
“carotenoids” OR “carotenoid*” OR “Carotenes” OR “Carotene” OR “retinoids” OR
“retinoid*” OR “Vitamin B1” OR “thiamin” OR “vitamin B1” OR “Vitamin B 1”
OR “Vitamin B-1” OR “Vitamin B(1)” OR “Aneurin” OR “Chloride” OR “Sodium,
Dietary” OR “Dietary Sodium” OR “Sodium” OR “electrolyte*”)
898 633
2
1 Timespan=(2000-2014)
575 890
3
Topic=(“Magnesium”)
120 004
4
3 Timespan=(2010.10.01-2014)
26 061
5
Topic=(“Copper”)
333 639
6
5 Limit 2011/01/01
54 383
7
2 OR 4 OR 6
645 381
EFSA supporting publication 2014:EN-629
136
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively
by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender
procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be
considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the
issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Web Of
Science
Search strategy
8
Topic=(“Milk, Human" OR “Breast Milk” OR “Breast Milks” OR “Milk, Breast”
OR “human milk” OR “Breastmilk” OR “Feeding, Breast” OR “Breastfeeding” OR
“Breast Feeding, Exclusive” OR “Exclusive Breast Feeding” OR “Breastfeeding,
Exclusive” OR “Exclusive Breastfeeding” OR “breast feeding” OR “women milk”
OR “women’s milk” OR “mother’s milk”)
32 991
9
7 AND 8
1 324
10
9 “NOT (Animals NOT Humans)”
1 305
Date of search 6th of January 2014
4.
Grey literature searches
URL
https://www.google
.pl/
http://scholar.googl
e.pl/
http://books.google.
com/?hl=pl
Access date
Search terms used
Specific features
Relevant reference
27.03.2014
"breast milk vitamin
A/retinol/carotenoids",
“breast milk vitamin
B1/vitamin B1”, “breast
milk chloride”, “breast milk
sodium”, “breast milk
copper”, “breast milk
magnesium“, “breast milk
nutrients”, “breast milk
composition” – in Polish
language
Period searched
from 2000 (vit A,
vit B1, sodium,
chloride) and 2010
(Mg), and 2011
(Cu), Polish
searches
No more
information than
that yet retrieved
from the databases
27.03.2014
""breast milk vitamin
A/retinol/carotenoids",
“breast milk vitamin
B1/vitamin B 1”, “breast
milk chloride”, “breast milk
sodium”, “breast milk
copper”, “breast milk
magnesium“, “breast milk
nutrients”, “breast milk
composition” – in Polish
language
Period searched
from 2000 (vit A,
vit B1, sodium,
chloride) and 2010
(Mg), and 2011
(Cu), Polish
searches
No relevant
information
27.03.2014
"breast milk vitamin
A/retinol/carotenoids",
“breast milk vitamin
B1/vitamin B 1”, “breast
milk chloride”, “breast milk
sodium”, “breast milk
copper”, “breast milk
magnesium“, “breast milk
nutrients”, “breast milk
composition” – in Polish
Period searched
from 2000 (vit A,
vit B1, sodium,
chloride) and 2010
(Mg), and 2011
(Cu), Polish
searches
No relevant
information
EFSA supporting publication 2014:EN-629
137
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively
by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender
procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be
considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the
issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
URL
Access date
Search terms used
Specific features
Relevant reference
27.03.2014
"breast milk vitamin
A/retinol/carotenoids",
“breast milk vitamin
B1/vitamin B 1”, “breast
milk chloride”, “breast milk
sodium”, “breast milk
copper”, “breast milk
magnesium“, “breast milk
nutrients”, “breast milk
composition” – in Polish
language
Polish searches
No relevant
information
27.03.2014
"breast milk vitamin
A/retinol/carotenoids",
“breast milk vitamin
B1/vitamin B 1”, “breast
milk chloride”, “breast milk
sodium”, “breast milk
copper”, “breast milk
magnesium“, “breast milk
nutrients”, “breast milk
composition” – in Polish
language
Polish searches
No relevant
information
27.03.2014
"breast milk vitamin
A/retinol/carotenoids",
“breast milk vitamin
B1/vitamin B 1”, “breast
milk chloride”, “breast milk
sodium”, “breast milk
copper”, “breast milk
magnesium“, “breast milk
nutrients”, “breast milk
composition” – in Polish
language
Polish searches
No relevant
information
27.03.2014
"breast milk vitamin
A/retinol/carotenoids",
“breast milk vitamin
B1/vitamin B 1”, “breast
milk chloride”, “breast milk
sodium”, “breast milk
copper”, “breast milk
magnesium“, “breast milk
nutrients”, “breast milk
composition” – in Polish
language
Polish searches
No relevant
information
language
http://www.ptzkd.or
g/
http://www.neonato
logia.edu.pl/
http://www.ptp.edu.
pl/
http://www.izz.waw
.pl/pl/
EFSA supporting publication 2014:EN-629
138
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively
by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender
procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be
considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the
issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Grey literature was searched by hand, using relevant keywords, more or less specific according to the
searched websites/databases (see the following table). Websites interface and structure were carefully
screened for identifying any relevant information.
URL
https://www.go
ogle.pl/
http://scholar.go
ogle.pl/
http://books.goo
gle.com/?hl=pl
Access date
Search terms used
Specific
features
Relevant
reference?
27.03.2014
"breast milk
vitamin
A/retinol/carotenoi
ds", “breast milk
vitamin B1/vitamin
B1”, “breast milk
chloride”, “breast
milk sodium”,
“breast milk
copper”, “breast
milk magnesium“,
“breast milk
nutrients”, “breast
milk composition”
– in Polish
language
Period searched
from 2000 (vit
A, vit B1,
sodium,
chloride) and
2010 (Mg), and
2011 (Cu),
Polish searches
No more
information
than that yet
retrieved from
the databases
27.03.2014
""breast milk
vitamin
A/retinol/carotenoi
ds", “breast milk
vitamin B1/vitamin
B 1”, “breast milk
chloride”, “breast
milk sodium”,
“breast milk
copper”, “breast
milk magnesium“,
“breast milk
nutrients”, “breast
milk composition”
– in Polish
language
Period searched
from 2000 (vit
A, vit B1,
sodium,
chloride) and
2010 (Mg), and
2011 (Cu),
Polish searches
No relevant
information
27.03.2014
"breast milk
vitamin
A/retinol/carotenoi
ds", “breast milk
vitamin B1/vitamin
B 1”, “breast milk
chloride”, “breast
milk sodium”,
“breast milk
copper”, “breast
milk magnesium“,
“breast milk
nutrients”, “breast
Period searched
from 2000 (vit
A, vit B1,
sodium,
chloride) and
2010 (Mg), and
2011 (Cu),
Polish searches
No relevant
information
EFSA supporting publication 2014:EN-629
Reason for
exclusion
139
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively
by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender
procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be
considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the
issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
URL
Specific
features
Relevant
reference?
27.03.2014
"breast milk
vitamin
A/retinol/carotenoi
ds", “breast milk
vitamin B1/vitamin
B 1”, “breast milk
chloride”, “breast
milk sodium”,
“breast milk
copper”, “breast
milk magnesium“,
“breast milk
nutrients”, “breast
milk composition”
– in Polish
language
Polish searches
No relevant
information
27.03.2014
"breast milk
vitamin
A/retinol/carotenoi
ds", “breast milk
vitamin B1/vitamin
B 1”, “breast milk
chloride”, “breast
milk sodium”,
“breast milk
copper”, “breast
milk magnesium“,
“breast milk
nutrients”, “breast
milk composition”
– in Polish
language
Polish searches
No relevant
information
27.03.2014
"breast milk
vitamin
A/retinol/carotenoi
ds", “breast milk
vitamin B1/vitamin
B 1”, “breast milk
chloride”, “breast
milk sodium”,
“breast milk
copper”, “breast
milk magnesium“,
“breast milk
nutrients”, “breast
Polish searches
No relevant
information
Access date
Search terms used
Reason for
exclusion
milk composition”
– in Polish
language
http://www.ptzk
d.org/
http://www.neo
natologia.edu.pl
/
http://www.ptp.
edu.pl/
EFSA supporting publication 2014:EN-629
140
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively
by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender
procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be
considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the
issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
URL
Access date
Search terms used
Specific
features
Relevant
reference?
Polish searches
No relevant
information
Reason for
exclusion
milk composition”
– in Polish
language
http://www.izz.
waw.pl/pl/
http://scientific.t
homsonwebplus
.com/
http://clinicaltri
als.gov/
http://www.oclc
.org/
27.03.2014
"breast milk
vitamin
A/retinol/carotenoi
ds", “breast milk
vitamin B1/vitamin
B 1”, “breast milk
chloride”, “breast
milk sodium”,
“breast milk
copper”, “breast
milk magnesium“,
“breast milk
nutrients”, “breast
milk composition”
– in Polish
language
"breast milk spec
micronutrient" ,
"breast milk spec
micronutrient",
"breast milk spec
micronutrient"
No more
information
than that yet
retrieved from
the databases
18.04.2014
"human milk spec
micronutrient" ,
"human milk spec
micronutrient",
"human milk spec
micronutrient"
18.04.2014
"breast milk”,
“human milk”
“spec
micronutrient”,
“spec
micronutrient"
18.04.2014
"breast milk”,
“human milk”
“spec
micronutrient”,
“spec
micronutrient"
EFSA supporting publication 2014:EN-629
Period searched
from 2000 (vit
A, vit B1,
sodium,
chloride) and
2010 (Mg), and
2011 (Cu)
No relevant
information
No relevant
information
141
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively
by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender
procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be
considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the
issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
URL
http://www.ope
ngrey.eu/
http://www.efsa
.europa.eu/
Access date
Search terms used
18.04.2014
"breast milk”,
“human milk”
“spec
micronutrient”,
“spec
micronutrient"
18.04.2014
Specific
features
Relevant
reference?
Reason for
exclusion
No relevant
information
"breast milk”,
“human milk”
“spec
micronutrient”,
“spec
micronutrient"
No relevant
information
Search by hand in
the reports
"breast milk”,
“human milk”
“spec
micronutrient”,
“spec
micronutrient"
http://www.anse
s.fr/
18.04.2014
“lait maternel”,
“spec
micronutrient”,
“spec
micronutrient”
French and
English
searches
No relevant
information
Advanced
search with
restriction to
articles
published from
2000 (vit A, vit
B1, sodium,
chloride); 2010
(Mg), and 2011
(Cu)
No relevant
information
Search by hand in
the reports
http://www.jstor
.org/
"breast milk spec
micronutrient" ,
"breast milk spec
micronutrient",
"breast milk spec
micronutrient"
18.04.2014
"human milk spec
micronutrient" ,
"human milk spec
micronutrient",
"human milk spec
micronutrient"
EFSA supporting publication 2014:EN-629
142
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively
by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender
procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be
considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the
issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
URL
http://www.grey
lit.org/
http://worldwid
escience.org/
http://www.scie
nce.gov/
http://www.coll
ectionscanada.g
c.ca/thesescana
da/
Access date
Search terms used
Specific
features
"breast milk spec
micronutrient" ,
"breast milk spec
micronutrient",
"breast milk spec
micronutrient"
"human milk spec
micronutrient" ,
"human milk spec
micronutrient",
"human milk spec
micronutrient"
"breast milk spec
micronutrient" ,
"breast milk spec
micronutrient",
"breast milk spec
micronutrient"
No relevant
information
18.04.2014
"human milk spec
micronutrient" ,
"human milk spec
micronutrient",
"human milk spec
micronutrient"
"breast milk spec
micronutrient" ,
"breast milk spec
micronutrient",
"breast milk spec
micronutrient"
No relevant
information
18.04.2014
"human milk spec
micronutrient" ,
"human milk spec
micronutrient",
"human milk spec
micronutrient"
18.04.2014
Reason for
exclusion
No relevant
information
18.04.2014
"breast milk”,
“human milk”
“spec
micronutrient”,
“spec
micronutrient"
Relevant
reference?
French and
English
searches
No relevant
information
“lait maternel”,
EFSA supporting publication 2014:EN-629
143
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively
by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender
procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be
considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the
issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
URL
Access date
Search terms used
Specific
features
Relevant
reference?
Advanced
search with
restriction to
articles
published from
2000 (vit A, vit
B1, sodium,
chloride); 2010
(Mg), and 2011
(Cu)
No relevant
information
Reason for
exclusion
“spec
micronutrient”,
“spec
micronutrient”
http://trove.nla.
gov.au/
http://scienceres
earch.com/
http://www.sud
oc.abes.fr/
"breast milk spec
micronutrient" ,
"breast milk spec
micronutrient",
"breast milk spec
micronutrient"
18.04.2014
"human milk spec
micronutrient" ,
"human milk spec
micronutrient",
"human milk spec
micronutrient"
"breast milk spec
micronutrient" ,
"breast milk spec
micronutrient",
"breast milk spec
micronutrient"
No relevant
information
18.04.2014
"human milk spec
micronutrient" ,
"human milk spec
micronutrient",
"human milk spec
micronutrient"
18.04.2014
"breast milk”,
“human milk”
“spec
micronutrient”,
“spec
micronutrient"
“lait maternel”,
“spec
micronutrient”,
“spec
micronutrient”
EFSA supporting publication 2014:EN-629
French and
English
searches
No relevant
information
144
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively
by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender
procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be
considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the
issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
E. REFERENCES FOR STUDIES EXCLUDED ON THE BASIS OF THE COUNTRY
1.
Data on folates
Han, Y. H., Yon, M. et al. (2009). "Folate concentrations in human milk and casein-based and soyabased formulas, and folate status in Korean infants." British Journal of Nutrition 101(12): 17691774.
Sakurai, T., Furukawa, M. et al. (2005). "Fat-soluble and water-soluble vitamin concentrations of
breast milk from Japanese women." Journal of Nutritional Science and Vitaminology 51(4): 239247.
Shi, Y. D., Sun, G. Q. et al. (2011). "The chemical composition of human milk from Inner Mongolia
of China." Food Chemistry 127(3): 1193-1198.
2.
Data on Zinc
Abdulrazzaq, Y. M., Osman, N. et al. (2008). "Trace element composition of plasma and breast milk
of well-nourished women." Journal of Environmental Science and Health - Part A Toxic/Hazardous
Substances and Environmental Engineering 43(3): 329-334.
Ahmed, L., Islam, S. et al. (2004). "Antioxidant micronutrient profile (Vitamin E, C, A, copper, zinc,
iron) of colostrum: Association with maternal characteristics." Journal of Tropical Pediatrics 50(6).
Al-Awadi, F. M. and Srikumar, T. S. (2000). "Trace-element status in milk and plasma of Kuwaiti and
non-Kuwaiti lactating mothers." Nutrition 16(11-12): 1069-1073.
Ali El-Farrash, R., Rahman Ismail, E. A. et al. (2012). "Cord blood iron profile and breast milk
micronutrients in maternal iron deficiency anemia." Pediatric Blood and Cancer 58(2): 233-238.
Anastacio, A. D. S., Da Silveira, C. L. P. et al. (2004). "Distribution of lead in human milk fractions:
Relationship with essential minerals and maternal blood lead." Biological Trace Element Research
102(1-3): 27-37.
Azevedo, P. M. C., Gavazzoni-dias, M. F. R. et al. (2008). "Acrodermatitis enteropathica in a full-term
breast-fed infant: Case report and literature review." International Journal of Dermatology 47(10):
1056-1057.
Becquey, E. and Martin-Prevel, Y. (2010). "Micronutrient adequacy of women's diet in urban Burkina
Faso is low." Journal of Nutrition 140(11): 2079S-2085S.
Berger, J., Ninh, N. X. et al. (2006). "Efficacy of combined iron and zinc supplementation on
micronutrient status and growth in Vietnamese infants." European Journal of Clinical Nutrition
60(4): 443-454.
Choua, G., Atalhi, N. et al. (2011). "Determination the quantity of zinc in serum and maternal milk of
Moroccan babies exclusively breastfeeding." Annals of Nutrition and Metabolism 58: 378-379.
Cooper, J., Krebs, N. et al. (2006). "Low maternal dietary zinc intake and breast milk zinc
concentrations in southern Ethiopia." Western abstracts 54(1): p S144.
EFSA supporting publication 2014:EN-629
145
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively
by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender
procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be
considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the
issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Correia-Santos, A. M., Bolognini, P. et al. (2011). "Dietary supplements for the lactating adolescent
mother: influence on plasma micronutrients." Nutrición Hospitalaria 26(2): 392-8.
Cunha, A., Dorea, J. et al. (2001). "Intrauterine device and maternal copper metabolism during
lactation." Contraception 63(1):37-9.
da Costa, R., do Carmo, M. et al. (2002). "Trace elements concentration of colostrum milk in Brazil."
JOURNAL OF FOOD COMPOSITION AND ANALYSIS 15(1): 27–33.
da Costa, R. S. S., do Carmo, M. G. T. et al. (2003). "Characterization of iron, copper and zinc levels
in the colostrum of mothers of term and pre-term infants before and after pasteurization."
International Journal of Food Sciences and Nutrition 54(2): 111-117.
De Mello Neto, J., De Carvalho Rondo, P. et al. (2011). "Effect of common supplements on status of
micronutrients of lactants of a human milk bank." Annals of Nutrition and Metabolism 58: 136137.
De Mello Neto, J., Rondo, P. H. C. et al. (2011). "Effect of mineral and/or vitamin supplements
usually consumed on iron, copper and zinc status of lactating women at a Brazilian human milk
bank." Tropical Medicine and International Health 16: 286.
De Pee, S. and Hautvast, J. G. A. J. (2005). "Variation in mineral concentrations in breast milk of
Guatemalan mothers and a tribute to Professor Clive E. West." Journal of Pediatric
Gastroenterology and Nutrition 40(2): 120-121.
Dewey, K. G., Cohen, R. J. et al. (2004). "Exclusive Breast-Feeding for 6 Months, with Iron
Supplementation, Maintains Adequate Micronutrient Status among Term, Low-Birthweight,
Breast-Fed Infants in Honduras." Journal of Nutrition 134(5): 1091-1098.
Dhonukshe-Rutten, R. A. M., Vossenaar, M. et al. (2005). "Day-to-day variations in iron, zinc and
copper in breast milk of Guatemalan mothers." Journal of Pediatric Gastroenterology and Nutrition
40(2): 128-134.
Dijkhuizen, M. A., Wieringa, F. T. et al. (2001). "Concurrent micronutrient deficiencies in lactating
mothers and their infants in Indonesia." American Journal of Clinical Nutrition 73(4): 786-791.
Dijkhuizen, M. A., Wieringa, F. T. et al. (2004). "Zinc plus (beta)-carotene supplementation of
pregnant women is superior to (beta)-carotene supplementation alone in improving vitamin A
status in both mothers and infants." American Journal of Clinical Nutrition 80(5): 1299-1307.
Donangelo, C. M., Zapata, C. L. V. et al. (2005). "Zinc absorption and kinetics during pregnancy and
lactation in Brazilian women." American Journal of Clinical Nutrition 82(1): 118-124.
Dorea, J. G. (2002). "Zinc and copper in breast-milk and home-prepared milk fed to urban infants
from low-income families." Journal of Trace Elements in Experimental Medicine 15(3): 123-129.
Dumrongwongsiri, O., Suthutvoravut, U. et al. (2013). "Maternal zinc status is associated with breast
milk zinc concentration and zinc status of 4-6 month old infants." Annals of Nutrition and
Metabolism 63: 611-612.
El Din, Z. M. E., El Ghaffar, S. A. et al. (2004). "Is stored expressed breast milk an alternative for
working Egyptian mothers?" Eastern Mediterranean Health Journal 10(6): 815-821.
EFSA supporting publication 2014:EN-629
146
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively
by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender
procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be
considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the
issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
El Fekih, N., Monia, K. et al. (2011). "Transient symptomatic zinc deficiency in a breast-fed infant:
Relevance of a genetic study." Nutrition 27(10): 1087-1089.
Eneroth, H., El Arifeen, S. et al. (2009). "Duration of exclusive breast-feeding and infant iron and zinc
status in rural Bangladesh." Journal of Nutrition 139(8): 1562-1567.
Goes, H. C. A., Torres, A. G. et al. (2002). "Nutrient composition of banked human milk in Brazil and
influence of processing on zinc distribution in milk fractions." Nutrition 18(7-8): 590-594.
Hannan, M. A., Dogadkin, N. N. et al. (2005). "Copper, selenium, and zinc concentrations in human
milk during the first three weeks of lactation." Biological Trace Element Research 107(1): 11-20.
Itsumura, N., Inamo, Y. et al. (2013). "Compound Heterozygous Mutations in SLC30A2/ZnT2 Results
in Low Milk Zinc Concentrations: A Novel Mechanism for Zinc Deficiency in a Breast-Fed
Infant." PLoS ONE 8(5).
Khaghani, S., Ezzatpanah, H. et al. (2010). "Zinc and copper concentrations in human milk and infant
formulas." Iranian Journal of Pediatrics 20(1): 53-57.
Kim, S. Y., Park, J. H. et al. (2012). "Longitudinal study on trace mineral compositions (selenium,
zinc, copper, manganese) in Korean human preterm milk." Korean Med Sci 27: 532-536.
Kosanovic, M., Adem, A. et al. (2008). "Simultaneous determination of cadmium, mercury, lead,
arsenic, copper, and zinc in human breast milk by ICP-MS/microwave digestion." Analytical
Letters 41(3): 406-416.
Mahdavi, R., Nikniaz, L. et al. (2010). "Association between zinc, copper, and iron concentrations in
breast milk and growth of healthy infants in Tabriz, Iran." Biological Trace Element Research
135(1-3): 174-181.
Maia, P. A., Figueiredo, R. C. B. et al. (2007). "Zinc and copper metabolism in pregnancy and
lactation of adolescent women." Nutrition 23(3): 248-253.
Mastroeni, S. S. B. S., Okada, I. A. et al. (2006). "Concentrations of Fe, K, Na, Ca, P, Zn and Mg in
maternal colostrum and mature milk." Journal of Tropical Pediatrics 52(4): 272-275.
Mello-neto, J., Rondo, P. H. et al. (2010). "Iron concentrations in breast milk and selected maternal
factors of human milk bank donors." Journal of Human Lactation 15(1): 27–33.
Mello-neto, J., Rondo, P. H. C. et al. (2009). "The influence of maternal factors on the concentration
of vitamin A in mature breast milk." Clinical Nutrition 28(2): 178-181.
Melnikov, P., Moura, A. J. D. C. et al. (2007). "Zinc and copper in colostrum." Indian Pediatrics
44(5): 355-357.
Murthy, S. C., Udagani, M. M. et al. (2010). "Symptomatic zinc deficiency in a full-term breast-fed
infant." Dermatology Online Journal 16(6).
Nakamori, M., Ninh, N. X. et al. (2009). "Nutritional status of lactating mothers and their breast milk
concentration of iron, zinc and copper in rural Vietnam." Journal of Nutritional Science and
Vitaminology 55(4): 338-345.
Nwosu, F., Adekola, F. et al. (2003). "Comparison of some preconcentration methods for certain metal
ions in human milk and yogurts." Bull. Chem. Soc. Ethiop. 17(1): 1-9.
EFSA supporting publication 2014:EN-629
147
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively
by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender
procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be
considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the
issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Rakicioglu, N., Samur, G. et al. (2006). "The effect of Ramadan on maternal nutrition and
composition of breast milk." Pediatrics International 48(3): 278-283.
Scheplyagina, L. A. (2005). "Impact of the mother's zinc deficiency on the woman's and newborn's
health status." Journal of Trace Elements in Medicine and Biology 19(1 SPEC. ISS.): 29-35.
Severi, C., Hambidge, M. et al. (2013). "Zinc in plasma and breast milk in adolescents and adults in
pregnancy and pospartum, a cohort study in Uruguay." Nutr Hosp 28(1): 223-228.
Shaaban, S. Y., El-Hodhod, M. A. A. et al. (2005). "Zinc status of lactating Egyptian mothers and their
infants: Effect of maternal zinc supplementation." Nutrition Research 25(1): 45-53.
Yang, W. L., Hsu, C. K. et al. (2012). "Transient zinc deficiency syndrome in a breast-fed infant due
to decreased zinc in breast milk (type II hypozincemia of infancy): A case report and review of the
literature." Dermatologica Sinica 30(2): 66-70.
3.
Data on Vitamin B6, Vitamin E, choline, phosphorus, potassium
Barkova, E. N., Nazarenko, E. V. et al. (2005). "Diurnal variations in qualitative composition of breast
milk in women with iron deficiency." Bulletin of Experimental Biology and Medicine 140(4): 394396.
Bishara, R., Dunn, M. S. et al. (2008). "Nutrient composition of hindmilk produced by mothers of very
low birth weight infants born at less than 28 weeks' gestation." Journal of Human Lactation 24(2):
159-167.
Braga, L. P. M. and Palhares, D. B. (2007). Effect of evaporation and pasteurization in the
biochemical and immunological composition of human milk. Jornal de Pediatria Efeito da
evaporacao e pasteurizacao na composicao bioquimica e imunologica do leite humano. 83: 59-63.
de Azeredo, V. B. and Trugo, N. M. (2008). "Retinol, carotenoids, and tocopherols in the milk of
lactating adolescents and relationships with plasma concentrations” Nutrition 24(2): 133-139."
Kamao, M., Tsugawa, N. et al. (2007). "Quantification of fat-soluble vitamins in human breast milk by
liquid chromatography-tandem mass spectrometry." Journal of Chromatography B: Analytical
Technologies in the Biomedical and Life Sciences 859(2): 192-200.
Kodentsova, V. M. and Vrzhesinskaya, O. A. (2006). "Evaluation of the vitamin status in nursing
women by vitamin concentration in breast milk." Bulletin of Experimental Biology and Medicine
141(3): 323-327.
Kositamongkol, S., Suthutvoravut, U. et al. (2011). "Vitamin A and E status in very low birth weight
infants." Journal of Perinatology 31(7): 471-476.
Lietz, G., Mulokozi, G. et al. (2006). "Xanthophyll and hydrocarbon carotenoid patterns differ in
plasma and breast milk of women supplemented with red palm oil during pregnancy and lactation."
Journal of Nutrition 136(7): 1821-1827.
Macias, C. and Schweigert, F. J. (2001). "Changes in the concentration of carotenoids, vitamin A,
alpha-tocopherol and total lipids in human milk throughout early lactation." Annals of Nutrition
and Metabolism 45(2): 82-85.
EFSA supporting publication 2014:EN-629
148
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively
by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender
procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be
considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the
issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Martinez, F. E., Sieber, V. M. et al. (2002). "Effect of supplementation of preterm formula with long
chain polyunsaturated Fatty acids on mineral balance in preterm.” Journal of Pediatric
Gastroenterology and Nutrition infants 35(4): 503-7."
Mastroeni, S. S. B. S., Okada, I. A. et al. (2006). "Concentrations of Fe, K, Na, Ca, P, Zn and Mg in
maternal colostrum and mature milk." Journal of Tropical Pediatrics 52(4): 272-275.
Mataloun, M. M. G. B. and Leone, C. R. (2000). "Human milk mineral intake and serum
concentrations of calcium and phosphorus in newborn term infants: Influence of intrauterine
growth restriction." Acta Paediatrica, International Journal of Paediatrics 89(9): 1093-1097.
Nikniaz, L., Mahdavi, R. et al. (2013). "Effects of synbiotic supplementation on total antioxidant
capacity of human breastmilk." Breastfeeding Medicine 8(2): 217-222.
Qiao, Y., Feng, J. et al. (2013). "The relationship between dietary vitamin A intake and the levels of
sialic acid in the breast milk of lactating women." Journal of Nutritional Science and Vitaminology
59(4): 347-351.
Tanaka, A., Rugolo, L. M. et al. (2006). "Fractional sodium excretion, urinary osmolality and specific
gravity in preterm infants fed with fortified donor human milk” Jornal de pediatria 82(5): 335-40.
Thomaz, D. M. C., Serafim, P. O. et al. (2012). "Comparison between homologous human milk
supplements and a commercial supplement for very low birth weight infants." Jornal de Pediatria
88(2): 119-124.
Todoroki, Y., Tsukahara, H. et al. (2005). "Concentrations of thioredoxin, a redox-regulating protein,
in umbilical cord blood and breast milk." Free Radical Research 39(3): 291-297.
Turner, T. and Burri, B. J. (2012). "Rapid isocratic HPLC method and sample extraction procedures
for measuring carotenoid, retinoid, and tocopherol concentrations in human blood and breast milk
for intervention studies." Chromatographia 75(5-6): 241-252.
Yagi, T., Iwamoto, S. et al. (2013). "Concentrations of all forms of vitamin B6, pyridoxine-(beta)glucoside and 4-pyridoxic acid in mature milk of Japanese women according to 4-pyridoxolactoneconversion high performance liquid chromatography." Journal of Nutritional Science and
Vitaminology 59(1): 9-15.
Zimmerman, D. R., Goldstein, L. et al. (2009). "Effect of a 24+ hour fast on breast milk composition."
Journal of Human Lactation 25(2): 194-198.
4.
Data on Vitamin A, Vitamin B1, chloride, copper, magnesium, sodium
Ahmed, L., Islam, S. et al. (2004). "Antioxidant micronutrient profile (Vitamin E, C, A, copper, zinc,
iron) of colostrum: Association with maternal characteristics." Journal of Tropical Pediatrics 50(6):
357-358.
Ali El-Farrash, R., Rahman Ismail, E. A. et al. (2012). "Cord blood iron profile and breast milk
micronutrients in maternal iron deficiency anemia." Pediatric Blood and Cancer 58(2): 233-238.
Ali, S. (2000). "Hypernatrenic dehydration in a neonate due to high sodium concentration in breast
milk and apparent lactation failure." Saudi Medical Journal 21(6): 593-595.
EFSA supporting publication 2014:EN-629
149
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively
by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender
procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be
considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the
issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Atalhi, N., Choua, G. et al. (2011). "Impact of daily consumption of Vitamin A fortified oil on human
milk Vitamin A concentration in lactating Moroccan women." Annals of Nutrition and Metabolism
58: 6.
Bahl, R., Bhandari, N. et al. (2002). "Vitamin A supplementation of women postpartum and of their
infants at immunization alters breast milk retinol and infant vitamin A status." Journal of Nutrition
132(11): 3243-3248.
Bezerra, D., de Araujo, K. et al. (2010). "A Randomized Trial Evaluating the Effect of 2 Regimens of
Maternal Vitamin A Supplementation on Breast Milk Retinol Levels." Journal of Human Lactation
26(2): 148-156.
Bhaskaram, P., Balakrishna, N. et al. (2000). "Vitamin A deficiency in infants: Effects of postnatal
maternal vitamin A supplementation on the growth and vitamin A status." Nutrition Research
20(6): 769-778.
Bishara, R., Dunn, M. S. et al. (2008). "Nutrient composition of hindmilk produced by mothers of very
low birth weight infants born at less than 28 weeks' gestation." Journal of Human Lactation 24(2):
159-167.
Braga, L. P. M. and Palhares, D. B. (2007). Effect of evaporation and pasteurization in the
biochemical and immunological composition of human milk. Jornal de Pediatria Efeito da
evaporacao e pasteurizacao na composicao bioquimica e imunologica do leite humano. 83: 59-63.
Caminha, M., Diniz, A. et al. (2008). "Serum retinol concentrations in hospitalized severe proteinenergy malnourished children." Journal of Tropical Pediatrics 54(4): 248-252.
Correia-Santos, A. M., Bolognini, P. et al. (2011). "Dietary supplements for the lactating adolescent
mother: influence on plasma micronutrients." Nutricion hospitalaria 26(2): 392-398.
de Azeredo, V. and Trugo, N. (2008). "Retinol, carotenoids, and tocopherols in the milk of lactating
adolescents and relationships with plasma concentrations." Nutrition 24: 133-139.
Dijkhuizen, M. A., Wieringa, F. T. et al. (2004). "Zinc plus (beta)-carotene supplementation of
pregnant women is superior to (beta)-carotene supplementation alone in improving vitamin A
status in both mothers and infants." American Journal of Clinical Nutrition 80(5): 1299-1307.
Estes, J., Craft, N. et al. (2002). "Analysis of vitamin A (VA) in breast milk (BM) and fortified sugar."
Faseb Journal 16(4).
Fernandes, T. F., Figueiroa, J. N. et al. (2011). "Effect on infant illness of maternal supplementation
with 400 000 IU vs 200 000 IU of vitamin A." PEDIATRICS 129(4): e960-966.
Fujita, M., Shell-Duncan, B. et al. (2011). "Vitamin A dynamics in breastmilk and liver stores: a life
history perspective." AMERICAN JOURNAL OF HUMAN BIOLOGY 23: 664-673.
Guimaraes, E., V, G. Schettino, et al. (2012). "Prevalence of Hyponatremia at Diagnosis and Factors
Associated with the Longitudinal Variation in Serum Sodium Levels in Infants with Cystic
Fibrosis." THE JOURNAL OF PEDIATRICS 161(2): 285-289.
Hsairi, M., Ben Hamouda, H. et al. (2006). Hypernatremic dehydration and breast-feeding. Journal de
Pediatrie et de Puericulture - Deshydratation hypernatremique et allaitement maternel. 19(7): 265267.
EFSA supporting publication 2014:EN-629
150
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively
by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender
procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be
considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the
issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Kamao, M., Tsugawa, N. et al. (2007). "Quantification of fat-soluble vitamins in human breast milk by
liquid chromatography-tandem mass spectrometry." Journal of Chromatography B: Analytical
Technologies in the Biomedical and Life Sciences 859(2): 192-200.
Kodentsova, V. M. and Vrzhesinskaya, O. A. (2006). "Evaluation of the vitamin status in nursing
women by vitamin concentration in breast milk." Bulletin of Experimental Biology and Medicine
141(3): 323-327.
Kositamongkol, S., Suthutvoravut, U. et al. (2011). "Vitamin A and E status in very low birth weight
infants." Journal of Perinatology 31(7): 471-476.
Lietz, G., Mulokozi, G. et al. (2006). "Xanthophyll and hydrocarbon carotenoid patterns differ in
plasma and breast milk of women supplemented with red palm oil during pregnancy and lactation."
Journal of Nutrition 136(7): 1821-1827.
Macias, C. and Schweigert, F. J. (2001). "Changes in the concentration of carotenoids, vitamin A,
alpha-tocopherol and total lipids in human milk throughout early lactation." Annals of Nutrition
and Metabolism 45(2): 82-85.
Marzouk, M., Neffati, F. et al. (2008). "A case of hypernatremic dehydration due to breast-feeding."
Ann Biol Clin 66(4): 471-474.
Mastroeni, S. S. B. S., Okada, I. A. et al. (2006). "Concentrations of Fe, K, Na, Ca, P, Zn and Mg in
maternal colostrum and mature milk." Journal of Tropical Pediatrics 52(4): 272-275.
Nikniaz, L., Mahdavi, R. et al. (2013). "Effects of synbiotic supplementation on total antioxidant
capacity of human breastmilk." Breastfeeding Medicine 8(2): 217-222.
Oliveira-Menegozzo, J., Bergamaschi, D. et al. (2000). "Vitamin A supplementation for postpartum
women." Cochrane Pregnancy and Childbirth Group.
Ratnakumari, T. L., Poovazhagi, V. et al. (2005). "Hypernatremic dehydration in a newborn with
inadequate lactation." Indian Journal of Practical Pediatrics 7(1): 71-73.
Ribeiro, K. D. S., Araujo, K. F. et al. (2007). Evaluation of retinol levels in human colostrum in two
samples collected at an interval of 24 hours. Jornal de Pediatria Avaliacao dos niveis de retinol no
colostro humano coletado no intervalo de 24 horas. 83: 377-380.
Semrau, K., Ghosh, M. et al. (2008). "Temporal and lateral dynamics of HIV shedding and elevated
sodium in breast milk among HIV-positive mothers during the first 4 months of breast-feeding."
Journal of Acquired Immune Deficiency Syndromes 47(3): 320-328.
Stuetz, W., Carrara, V. I. et al. (2012). "Vitamin B1 diphosphate in whole blood, vitamin B1 and
vitamin B1 monophosphate in breast-milk in a refugee population." PLoS ONE 7(6).
Stuetz, W., Carrara, V. I. et al. (2012). "Micronutrient status in lactating mothers before and after
introduction of fortified flour: Cross-sectional surveys in Maela refugee camp." European Journal
of Nutrition 51(4): 425-434.
Thatrimontrichai, A. and Janjindamai, W. (2011). "Safety of superfortification of human milk for
preterm." Asian Biomedicine 5(6): 825-830.
EFSA supporting publication 2014:EN-629
151
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively
by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender
procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be
considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the
issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Thomaz, D. M. C., Serafim, P. O. et al. (2012). "Comparison between homologous human milk
supplements and a commercial supplement for very low birth weight infants." Jornal de Pediatria
88(2): 119-124.
Turner, T. and Burri, B. J. (2012). "Rapid isocratic HPLC method and sample extraction procedures
for measuring carotenoid, retinoid, and tocopherol concentrations in human blood and breast milk
for intervention studies." Chromatographia 75(5-6): 241-252.
Vinutha, B., Mehta, M. N. et al. (2000). "Vitamin a status of pregnant women and effect of post
partum Vitamin A supplementation." Indian Pediatrics 37(11): 1188-1193.
Yaseen, H., Salem, M. et al. (2004). "Clinical presentation of hypernatremic dehydration in
exclusively breast-fed neonates." Indian Journal of Pediatrics 71(12): 1059-1062.
Zaki, S. A., Mondkar, J. et al. (2012). "Hypernatremic dehydration due to lactation failure in an
exclusively breastfed neonate." Saudi J Kidney Dis Transpl 23(1): 125-128.
EFSA supporting publication 2014:EN-629
152
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively
by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender
procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be
considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the
issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
F. REFERENCES FOR STUDIES EXCLUDED ON THE BASIS OF THE LANGUAGE
1.
Data on folates
No study.
2.
Data on zinc
Benedix, F., Hermann, U. et al. (2008). Transient zinc deficiency in preterm infants. Hautarzt.
Transiente zinkmangeldermatitis des fruhgeborenen. 59: 563-566.
Cambiaghi, S., Sala, F. et al. (2001). Acquired zinc deficiency in a premature breast-fed infant.
Giornale Italiano di Dermatologia e Venereologia. Deficit di zinco reversibile in una neonata
prematura. 136: 389-393.
Ehsani, P., Afshari, P. et al. (2009). "Effect of iron supplementation on zinc and magnesium
concentrations in maternal milk and plasma." Koomesh 10(4): 229-235.
Ergul, A. B., Ozturk, M. A. et al. (2010). The comparison of zinc, copper and iron concentration in
preterm and term babies mother's milk. Turk Pediatri Arsivi. Erken ve zamaninda dogmus
bebeklerin anne sutlerinin cinko, bakir ve demir duzeylerinin karsilastirilmasi. 45: 272-279.
Navarro Blasco, I., Sola Larranaga, C. et al. (2004). Present knowledge and research perspectives on
trace elements in infant nutrition (II). Concentrations and dietary intake. Acta Pediatrica Espanola.
Conocimientos actuales y perspectivas de investigacion de elementos traza en la nutricion infantil
(II): Valores de concentracion e ingestion dietetica. 62: 108-117.
Queiroz Bortolozo, E. A. F., Borges Tiboni, E. et al. (2004). Milk from human milk banks for low
birthweight newborns: Nutritional concentrations and supplementation. Revista Panamericana de
Salud Publica/Pan American Journal of Public Health. Leite humano processado em bancos de leite
para o recem-nascido de baixo peso: Analise nutricional e proposta de um novo complemento. 16:
199-205.
Ronayne, d., Weisstaub, A. et al. (2011). "[Zinc levels in term and preterm milk]." Arch Latinoam
Nutr 51(1): 33-36.
3.
Data on Vitamin B6, Vitamin E, choline, phosphorus and potassium
Aydin, I., Ozgurtas, T. et al. (2009). Biochemical comparison of preterm and term newborn's mother's
milk. Turkish Journal of Biochemistry Preterm ve term yenidoganlarin anne sutunun biyokimyasal
karsilastirmasi. 34: 242-249.
de Lira, L. Q., Ribeiro, P. P. et al. (2012). "[Alpha-tocopherol level in serum and colostrum of
breastfeeding women and association with maternal variables]." Rev Bras Ginecol Obstet 34(8):
362-368.
Dimenstein, R., Lira, L. et al. (2011). "[Effect of vitamin E supplementation on alpha-tocopherol
levels in human colostrum]." Rev Panam Salud Publica 29(6): 399-403.
EFSA supporting publication 2014:EN-629
153
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively
by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender
procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be
considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the
issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.
Vitamin and mineral content of breast milk
Dimenstein, R., Pires, J. F. et al. (2010). "[Levels of alpha-tocopherol in maternal serum and
colostrum of adolescents and adults]." Rev Bras Ginecol Obstet 32(6): 267-272.
Navarro Blasco, I., Sola Larranaga, C. et al. (2004). Present knowledge and research perspectives on
trace elements in infant nutrition (II). Concentrations and dietary intake. Acta Pediatrica Espanola
Conocimientos actuales y perspectivas de investigacion de elementos traza en la nutricion infantil
(II): Valores de concentracion e ingestion dietetica. 62: 108-117.
Queiroz Bortolozo, E. A. F., Borges Tiboni, E. et al. (2004). Milk from human milk banks for low
birthweight newborns: Nutritional concentrations and supplementation. Revista Panamericana de
Salud Publica/Pan American Journal of Public Health Leite humano processado em bancos de leite
para o recem-nascido de baixo peso: Analise nutricional e proposta de um novo complemento. 16:
199-205.
4.
Data on Vitamin A, Vitamin B1, chloride, copper, magnesium, sodium
Dimenstein, R., Ribeiro Do Nascimento, T. H. C. et al. (2006). Evaluation of retinol levels in the
human colostrum and its relation with maternal vitamin A nourishing state. Revista Brasileira de
Medicina Avaliaao dos niveis de retinol no colostro humano e a sua relacao com o estado
nutricional materno em vitamina A. 63: 206-210.
Ergin, H., Sahin, O. et al. (2013). Hypernatremic dehydration in breastfed infants. Guncel Pediatri
Anne sutuyle beslenen yenidoganlarda hipernatremik dehidratasyon. 11: 51-56.
Penalver Giner, O., Gisbert Mestre, J. et al. (2004). Hypernatremic dehydration associated with breastfeeding. Anales de Pediatria Deshidratacion hipernatremica asociada a lactancia materna. 61: 340343.
Queiroz Bortolozo, E. A. F., Borges Tiboni, E. et al. (2004). Milk from human milk banks for low
birthweight newborns: Nutritional concentrations and supplementation. Revista Panamericana de
Salud Publica/Pan American Journal of Public Health Leite humano processado em bancos de leite
para o recem-nascido de baixo peso: Analise nutricional e proposta de um novo complemento. 16:
199-205.
EFSA supporting publication 2014:EN-629
154
The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively
by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender
procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be
considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the
issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.