Preterm ve Term Bebeklerden Elde Edilen Anne Sütlerinin Makro ve Mikro Besin Bileşimlerinin Karşılaştırmalı Analizi: Beslenme Stratejileri İçin Çıkarımlar

Abstract

Anne sütü (HM), bebeğin gelişimsel ihtiyaçlarına göre özelleşmiş besinler ve immünolojik bileşenler sağlayan dinamik ve biyolojik olarak aktif bir sıvıdır. HM'nin bileşimi, gebelik yaşı, anne beslenmesi, genetik geçmiş ve çevresel faktörlere bağlı olarak önemli ölçüde değişiklik gösterir. Bu derlemenin amacı, preterm ve term bebeklerden elde edilen HM'nin makro ve mikro besin bileşimlerini sistematik bir şekilde karşılaştırmak ve bu farkların neonatal büyüme, bağışıklık fonksiyonu ve klinik beslenme stratejileri üzerindeki etkilerini değerlendirmektir. Preterm sütü, özellikle protein kalitesi, serbest amino asit içeriği, yağ asidi profili, vitamin konsantrasyonları ve immünolojik faktörler açısından term sütünden belirgin şekilde farklıdır. α-laktalbumin, laktoferrin, sIgA, lizozim ve orta zincirli trigliseritler ile zenginleşmiş olan preterm sütü, bağışıklık fonksiyonu ve nörogelişimi desteklemede önemli bir rol oynar. Ancak, genellikle glutamin, DHA ve demir ile fosfor gibi mineraller gibi temel besin öğeleri bakımından daha düşüktür ve bu nedenle hedeflenmiş takviye gereklidir. Anne diyetinin alımı, vitaminler (örneğin, A, D, B12 ve C) ve yağ asitleri seviyelerini önemli ölçüde etkilerken, genetik polimorfizmler de HM'nin lipid ve oligosakkarit bileşimini etkiler. Preterm ve term HM arasındaki bileşimsel farkların anlaşılması, bireyselleştirilmiş beslenme müdahaleleri için yol gösterici olacaktır. Preterm bebekler, yeterli besin sağlanması, bağışıklık desteği ve optimal nörogelişimsel sonuçlar için anne sütü takviyesi ve anne diyetinin optimize edilmesinden fayda görebilir.

Keywords

• Anne sütü
• Preterm bebekler
• Term bebekler
• Makro besinler
• Mikro besinler
• Beslenme stratejileri

Comparative Analysis of Macronutrient and Micronutrient Composition in Human Milk from Preterm and Term Infants: Implications for Nutritional Strategies

Abstract

Human milk (HM) is a dynamic and bioactive fluid that provides essential nutrients and immunological components tailored to infant developmental needs. The composition of HM varies significantly depending on gestational age, maternal nutrition, genetic background, and environmental factors. This review aims to systematically compare the macronutrient and micronutrient composition of HM from preterm and term infants, and to evaluate the implications of these differences for neonatal growth, immune function, and clinical nutrition strategies. Preterm milk differs markedly from term milk, particularly in protein quality, free amino acid content, fatty acid profile, vitamin concentrations, and immunological factors. It is enriched with α-lactalbumin, lactoferrin, sIgA, lysozyme, and medium-chain triglycerides, offering enhanced support for immune function and neurodevelopment. However, it is often lower in key nutrients such as glutamine, DHA, and minerals like iron and phosphorus, necessitating targeted fortification. Maternal dietary intake significantly affects the levels of vitamins (e.g., A, D, B12, and C) and fatty acids, while genetic polymorphisms also influence the lipid and oligosaccharide composition of HM. Understanding the compositional differences between preterm and term HM is essential for guiding individualized nutritional interventions. Clinically, fortification of preterm HM and alignment with the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN), the American Academy of Pediatrics (AAP), and the World Health Organization (WHO) guidelines are critical to ensure adequate nutrient delivery and optimal neurodevelopmental outcomes. Future research should focus on the long-term effects of variable DHA and HMO levels, and the influence of maternal nutrition and genetics on milk composition.

Keywords

• Human milk
• Preterm infants
• Term infants
• Macronutrients
• Micronutrients
• Nutritional strategies

References

1. Abrams SA, 2013: Calcium and vitamin D requirements of enterally fed preterm infants. Pediatrics, 131, e1676-e1683.
2. Abrams SA, 2020: Vitamin D in preterm and full-term infants. Ann Nutr Metab, 76, 6-14.
3. Açar Y, Yassıbaş E, 2021: Anne sütü oligosakkaritleri ve sağlık üzerine etkileri. Gazi Sağlık Bil Derg, 6, 22-33.
4. Affolter M, Garcia-Rodenas CL, Vinyes-Pares G, Jenni R, Roggero I, Avanti-Nigro O, De Castro CA, Zhao A, Zhang Y, Wang P, 2016: Temporal changes of protein composition in breast milk of Chinese urban mothers and impact of caesarean section delivery. Nutrients, 8, 504.
5. Aggett PJ, Agostoni C, Axelsson I, De Curtis M, Goulet O, Hernell O, Koletzko B, Lafeber HN, Michaelsen KF, Puntis JW, 2006: Feeding preterm infants after hospital discharge: a commentary by the ESPGHAN Committee on Nutrition. J Pediatr Gastroenterol Nutr, 42, 596-603.
6. Ahmed L, Islam SN, Khan MNI, Huque S, Ahsan M, 2004: Antioxidant micronutrient profile (Vitamin E, C, A, Copper, Zinc, Iron) of colostrum: Association with maternal characteristics. J Trop Pediatr, 50, 357-358.
7. Albi E, Arcuri C, Kobayashi T, Tomishige N, Dei Cas M, Paroni R, Signorelli P, Cerquiglini L, Troiani S, Gizzi C, 2022: Sphingomyelin in human breast milk might be essential for hippocampus maturation. Front Biosci, 27, 1-10.
8. Alexandre-Gouabau MC, Moyon T, David-Sochard A, Fenaille F, Cholet S, Royer AL, Guitton Y, Billard H, Darmaun D, Rozé JC, 2019: Comprehensive preterm breast milk metabotype associated with optimal infant early growth pattern. Nutrients, 11, 528.

9. Alkan Polat B, Aydemir Atasever M, 2019: Evaluation of breast milk from different perspectives. 1st International 4th Traditional Health Professionals Days, 193-197.
10. Alkan Polat B, Aydemir Atasever M, Polat H, Kılıç Baygutalp N, Atasever M, Öztürk N, Bakan E, 2015: Vitamin B12 and folate levels in human milk from mothers of preterm infants at different lactation stages. International Eurasia Pharmacy Congress, Erzincan, Turkey.
11. Alkanani T, Friel JK, Jackson SE, Longerich HP, 1994: Comparison between digestion procedures for the multielemental analysis of milk by inductively coupled plasma mass spectrometry. J Agric Food Chem, 42, 1965-1970.
12. Andreas NJ, Kampmann B, Le-Doare KM, 2015: Human breast milk: A review on its composition and bioactivity. Early Hum Dev, 91, 629-635.
13. Ardell S, Offringa M, Ovelman C, Soll RJ, 2018: Prophylactic vitamin K for the prevention of vitamin K deficiency bleeding in preterm neonates. (Cochrane Database Syst Rev)
14. Arslanoglu S, Boquien CY, King C, Lamireau D, Tonetto P, Barnett D, Bertino E, Gaya A, Gebauer C, Grovslien A, Moro GE, Weaver G, Wesolowska AM, Picaud JC, 2019: Fortification of human milk for preterm infants: Update and recommendations of the European Milk Bank Association (EMBA) Working Group on Human Milk Fortification. Front Pediatr, 7, 76.
15. Atasever M, Yildirim Y, Atasever M, Tastekin A, 2014: Assessment of aflatoxin M1 in maternal breast milk in Eastern Turkey. Food Chem Toxicol, 66, 147-149.
16. Atinmo T, Omololu A, 1982: Trace element content of breastmilk from mothers of preterm infants in Nigeria. Early Hum Dev, 6, 309-313.
17. Atkinson SA, Chappell JE, Clandinin MT, 1987: Calcium supplementation of mothers' milk for low birthweight infants: Problems related to absorption and excretion. Nutr Res, 7, 813-823.
18. Aureli M, Grassi S, Prioni S, Sonnino S, Prinetti A, 2015: Lipid membrane domains in the brain. Biochim Biophys Acta Mol Cell Biol Lipids, 1851, 1006-1016.
19. Austin S, De Castro CA, Sprenger N, Binia A, Affolter M, Garcia-Rodenas CL, Beauport L, Tolsa JF, Fischer Fumeaux CJ, 2019: Human milk oligosaccharides in the milk of mothers delivering term versus preterm infants. Nutrients, 11.
20. Aydemir Atasever M, Alkan Polat B, 2019: Vitamin-D levels of breast milk in different lactations. 1st International 4th Traditional Health Professionals Days, Erzurum, Turkey, 188-192.
21. Baldeón ME, Zertuche F, Flores N, Fornasini M, 2019: Free amino acid content in human milk is associated with infant gender and weight gain during the first four months of lactation. Nutrients, 11, 2239.
22. Bardanzellu F, Fanos V, Reali A, 2017: “Omics” in human colostrum and mature milk: Looking to old data with new eyes. Nutrients, 9, 843.
23. Bauer J, Gerss J, 2011: Longitudinal analysis of macronutrients and minerals in human milk produced by mothers of preterm infants. Clin Nutr, 30, 215-220.
24. Bénet T, Frei N, Spichtig V, Cuany D, Austin S, 2024: Determination of seven human milk oligosaccharides (HMOs) in infant formula and adult nutritionals: First Action 2022.07. J AOAC Int, 107, 286-302.
25. Bitman J, Wood L, Hamosh M, Hamosh P, Mehta N, 1983: Comparison of the lipid composition of breast milk from mothers of term and preterm infants. Am J Clin Nutr, 38, 300-312.
26. Bokor S, Koletzko B, Decsi T, 2008: Systematic review of fatty acid composition of human milk from mothers of preterm compared to full-term infants. Ann Nutr Metab, 51, 550-556.
27. Bravi F, Wiens F, Decarli A, Dal Pont A, Agostoni C, Ferraroni M, 2016: Impact of maternal nutrition on breast-milk composition: A systematic review. Am J Clin Nutr, 104, 646-662.
28. Carratù B, Boniglia C, Scalise F, Ambruzzi AM, Sanzini E, 2003: Nitrogenous components of human milk: Non-protein nitrogen, true protein and free amino acids. Food Chem, 81, 357-362.
29. Castillo F, Castillo-Ferrer FJ, Cordobilla B, Domingo JC, 2021: Inadequate content of docosahexaenoic acid (DHA) of donor human milk for feeding preterm infants: A comparison with mother’s own milk at different stages of lactation. Nutrients, 13, 1300.
30. Chaturvedi N, Gupta B, Sahrawat N, Dua S, Kumari C, Mittal S, 2024: Human milk oligosaccharides: Potential upshot on health at early life stage development. Nutrients, 12, 283-295.
31. Clarke P, 2010: Vitamin K prophylaxis for preterm infants. Early Hum Dev, 86, 17-20.
32. Czosnykowska-Łukacka M, Królak-Olejnik B, Orczyk-Pawiłowicz M, 2018: Breast milk macronutrient components in prolonged lactation. Nutrients, 10, 1893.
33. de Figueiredo CSM, Palhares DB, Melnikov P, da Cruz Montes Moura AJ, dos Santos SC, 2010: Zinc and copper concentrations in human preterm milk. Biol Trace Elem Res, 136, 1-7.
34. Donald K, Petersen C, Turvey SE, Finlay BB, Azad MB, 2022: Secretory IgA: Linking microbes, maternal health, and infant health through human milk. Cell Host Microbe, 30, 650-659.
35. Dórea JG, 2012: Zinc and copper concentrations in breastmilk. Indian Pediatr, 49, 592.
36. Dror DK, Allen LH, 2018: Overview of nutrients in human milk. Am J Nutr, 9, 278S-294S.
37. Ersoy D, Meral Koç B, 2023: Preterm ve düşük doğum ağırlıklı bebeklerde demir eksikliği ve demir proflaksisi kullanımı. Sağlık ve Yaşam Bilimleri Dergisi, 5, 56-62.
38. Farooqui AA, Horrocks LA, Farooqui TJ, 2000: Glycerophospholipids in brain: Their metabolism, incorporation into membranes, functions, and involvement in neurological disorders. Lipids, 106, 1-29.
39. Favara G, Maugeri A, Barchitta M, Lanza E, Magnano San Lio R, Agodi A, 2025: Maternal lifestyle factors affecting breast milk composition and infant health: A systematic review. Nutrients, 17, 62.
40. Fernandez-Menendez S, Fernandez-Sanchez ML, Fernandez-Colomer B, de la Flor St RR, Cotallo GDC, Freire AS, Braz BF, Santelli RE, Sanz-Medel A, 2016: Total zinc quantification by inductively coupled plasma-mass spectrometry and its speciation by size exclusion chromatography–inductively coupled plasma-mass spectrometry in human milk and commercial formulas: Importance in infant nutrition. J Chromatogr A, 1428, 246-254.
41. Fischer Fumeaux CJ, Garcia-Rodenas CL, De Castro CA, Courtet-Compondu MC, Thakkar SK, Beauport L, Tolsa JF, Affolter M, 2019: Longitudinal analysis of macronutrient composition in preterm and term human milk: A prospective cohort study. Nutrients, 11, 1525.
42. Floris L, Stahl B, Abrahamse-Berkeveld M, Teller IC, 2020: Human milk fatty acid profile across lactational stages after term and preterm delivery: A pooled data analysis. Prostaglandins Leukot Essent Fatty Acids, 156, 102023.
43. Garcia C, Duan RD, Brévaut-Malaty V, Gire C, Millet V, Simeoni U, Bernard M, Armand M, 2013: Bioactive compounds in human milk and intestinal health and maturity in preterm newborns: An overview. Cell Mol Biol, 59, 108-131.
44. Gidrewicz DA, Fenton TR, 2014: A systematic review and meta-analysis of the nutrient content of preterm and term breast milk. BMC Pediatr, 14, 1-14.
45. Gomes MM, de Lima APPT, da Silva LdSV, Lento DF, de Souza GG, Saunders C, Ramalho RA, 2005: Vitamina A e broncodisplasia pulmonar. Rev Ciências Médicas, 14.
46. Grapov D, Lemay DG, Weber D, Phinney BS, Azulay Chertok IR, Gho DS, German JB, Smilowitz JT, 2015: The human colostrum whey proteome is altered in gestational diabetes mellitus. J Proteome Res, 14, 512-520.
47. Gross SJ, David RJ, Bauman L, Tomarelli RJ, 1980: Nutritional composition of milk produced by mothers delivering preterm. J Pediatr, 96, 641-644.
48. Guo J, Ren C, Han X, Huang W, You Y, Zhan J, 2021: Role of IgA in the early-life establishment of the gut microbiota and immunity: Implications for constructing a healthy start. Gut Microbes, 13, 1908101.
49. Guo M, 2025: Human milk biochemistry and infant formula manufacturing technology. In: Functional Foods, Elsevier, 327-362.
50. Hay W, Ziegler E, 2016: Growth failure among preterm infants due to insufficient protein is not innocuous and must be prevented. J Perinatol, 36, 500-502.
51. Heird WC, 2001: The role of polyunsaturated fatty acids in term and preterm infants and breastfeeding mothers. Pediatr Clin North Am, 48, 173-188.
52. Huang C, Lu Y, Kong L, Guo Z, Zhao K, Xiang Z, Ma X, Gao H, Liu Y, Gao Z, Xu L, Chai W, Li Y, Zhao Y, 2023: Human milk oligosaccharides in milk of mothers with term and preterm delivery at different lactation stages. Carbohydr Polym, 321, 121263.
53. Hurley WL, Theil PK, 2011: Perspectives on immunoglobulins in colostrum and milk. Nutrients, 3, 442-474.
54. Innis SM, 2014: Impact of maternal diet on human milk composition and neurological development of infants. Am J Clin Nutr, 99, 734S-741S.
55. Jackson PPJ, Wijeyesekera A, Rastall RA, 2022: Determining the metabolic fate of human milk oligosaccharides: It may just be more complex than you think? Gut Microbiome, 3, e9.
56. Jantscher-Krenn E, Bode L, 2012: Human milk oligosaccharides and their potential benefits for the breast-fed neonate. Minerva Pediatr, 64, 83-99.
57. Kim SY, Yi DY, 2020: Components of human breast milk: From macronutrient to microbiome and microRNA. Clin Exp Pediatr, 63, 301-309.
58. Koletzko B, Brands B, Poston L, Godfrey K, Demmelmair H, 2012: Early nutrition programming of long-term health. Proc Nutr Soc, 71, 371-378.
59. Koo W, Gupta J, 1982: Breast milk sodium. Arch Dis Child, 57, 500-502.
60. Kovács A, Funke S, Marosvölgyi T, Burus I, Decsi T, 2005: Fatty acids in early human milk after preterm and full-term delivery. J Pediatr Gastroenterol Nutr, 41, 454-459.
61. Köksal N, Akpınar R, Köse H, Sayrım K, 2003: Prematüre ve yenidoğan beslenmesi. Güncel Pediatri, 1, 59-72.
62. Leaf A, Lansdowne Z, 2014: Vitamins—conventional uses and new insights. World Rev Nutr Diet, 110, 152-166.
63. Leaf A, Subramanian S, Cherian S, 2004: Vitamins for preterm infants. Curr Paediatr, 14, 298-305.
64. Lemons JA, Moye L, Hall D, Simmons MJ, 1982: Differences in the composition of preterm and term human milk during early lactation. Pediatr Res, 16, 113-117.
65. Li Z, Wang X, Deng X, Song J, Yang T, Liao Y, Gong G, Huang L, Lu Y, Wang Z, 2023: High-sensitivity qualitative and quantitative analysis of human, bovine and goat milk glycosphingolipids using HILIC-MS/MS with internal standards. Carbohydr Polym, 312, 120795.
66. Liang X, Han H, Zhao X, Cao X, Yang M, Tao D, Wu R, Yue X, 2018: Quantitative analysis of amino acids in human and bovine colostrum milk samples through iTRAQ labeling. J Sci Food Agric, 98, 5157-5163.
67. Lima MSR, da Silva Ribeiro KD, Pires JF, Bezerra DF, Bellot PENR, de Oliveira Weigert LP, Dimenstein R, 2017a: Breast milk retinol concentration in mothers of preterm newborns. Early Hum Dev, 106, 41-45.
68. Liu B, Newburg DS, 2013: Human milk glycoproteins protect infants against human pathogens. Breastfeed Med, 8, 354-362.
69. Lönnerdal B, 1986: Effects of maternal dietary intake on human milk composition. J Nutr Biochem, 116, 499-513. Lönnerdal B, 2017: Bioactive proteins in human milk—potential benefits for preterm infants. Clin Perinatol, 44, 179-191.
70. Lubetzky R, Zaidenberg-Israeli G, Mimouni FB, Dollberg S, Shimoni E, Ungar Y, Mandel D, 2012: Human milk fatty acids profile changes during prolonged lactation: A cross-sectional study. Isr Med Assoc J, 14, 7-10.
71. Luukkainen P, Salo MK, Nikkari T, 1994: Changes in the fatty acid composition of preterm and term human milk from 1 week to 6 months of lactation. J Pediatr Gastroenterol Nutr, 18, 355-360.
72. Macpherson AJ, Geuking MB, McCoy KD, 2012: Homeland security: IgA immunity at the frontiers of the body. Trends Immunol, 33, 160-167.
73. Martinez Galan BS, Giolo De Carvalho F, Carvalho SCS, Cunha Brandao CF, Morhy Terrazas SI, Abud GF, Meirelles MSS, Sakagute S, Ueta Ortiz G, Marchini JS, Aristizabal JC, Cristini de Freitas E, 2021: Casein and whey protein in the breast milk ratio: Could it promote protein metabolism enhancement in physically active adults? Nutrients, 13, 2153.
74. Mendelson R, Anderson G, Bryan M, 1982: Zinc, copper and iron content of milk from mothers of preterm and full-term infants. Early Hum Dev, 6, 145-151.
75. Miliku K, Duan QL, Moraes TJ, Becker AB, Mandhane PJ, Turvey SE, Lefebvre DL, Sears MR, Subbarao P, Field CJ, Azad MB, 2019: Human milk fatty acid composition is associated with dietary, genetic, sociodemographic, and environmental factors in the CHILD Cohort Study. Am J Clin Nutr, 110, 1370-1383.
76. Mimouni FB, Mandel D, Lubetzky R, Senterre T, 2014: Calcium, phosphorus, magnesium and vitamin D requirements of the preterm infant. World Rev Nutr Diet, 110, 140-151.
77. Molinari CE, Casadio YS, Hartmann BT, Livk A, Bringans S, Arthur PG, Hartmann PE, 2012: Proteome mapping of human skim milk proteins in term and preterm milk. J Proteome Res, 11, 1696-1714.
78. Moltó-Puigmartí C, Plat J, Mensink RP, Müller A, Jansen E, Zeegers MP, Thijs C, 2010: FADS1 FADS2 gene variants modify the association between fish intake and the docosahexaenoic acid proportions in human milk. Am J Clin Nutr, 91, 1368-1376.
79. Newburg DS, Walker WA, 2007: Protection of the neonate by the innate immune system of developing gut and of human milk. Pediatr Res, 61, 2-8.
80. O'Connor DL, Kiss A, Tomlinson C, Bando N, Bayliss A, Campbell DM, Daneman A, Francis J, Kotsopoulos K, Shah PS, Vaz S, Williams B, Unger S, 2018: Nutrient enrichment of human milk with human and bovine milk-based fortifiers for infants born weighing <1250 g: A randomized clinical trial. Am J Clin Nutr, 108, 108-116.
81. O'Rourke L, Clarke G, Nolan A, Watkins C, Dinan TG, Stanton C, Ross RP, Ryan CA, 2018: Tryptophan metabolic profile in term and preterm breast milk: Implications for health. J Nutr Sci, 7, e13.
82. Ochoa TJ, Cleary TG, 2009: Effect of lactoferrin on enteric pathogens. Biochimie, 91, 30-34.
83. Oliveira JMd, Rondó PHdC, 2007: Evidências do impacto da suplementação de vitamina A no grupo materno-infantil. Cad Saúde Pública, 23, 2565-2575.
84. Organization WH, UNICEF, 2003: Global strategy for infant and young child feeding. World Health Organization. Pammi M, Suresh G, 2017: Enteral lactoferrin supplementation for prevention of sepsis and necrotizing enterocolitis in preterm infants. Cochrane Database Syst Rev, 6, CD007137.
85. Perrone L, Di Palma L, Di Toro R, Gialanella G, Moro R, 1994: Interaction of trace elements in a longitudinal study of human milk from full-term and preterm mothers. Biol Trace Elem Res, 41, 321-330.
86. Petersohn I, Hellinga AH, van Lee L, Keukens N, Bont L, Hettinga KA, Feskens EJM, Brouwer-Brolsma EM, 2023: Maternal diet and human milk composition: An updated systematic review. Front Nutr, 10, 1320560.
87. Radmacher PG, Adamkin DH, 2017: Fortification of human milk for preterm infants. Semin Fetal Neonatal Med, 22, 30-35.
88. Ramanan D, Sefik E, Galván-Peña S, Wu M, Yang L, Yang Z, Kostic A, Golovkina TV, Kasper DL, Mathis D, 2020: An immunologic mode of multigenerational transmission governs a gut Treg setpoint. Cell, 181, 1276-1290.e1213.
89. Ramel SE, Georgieff MK, 2014: Preterm nutrition and the brain. World Rev Nutr Diet, 110, 190-200.
90. Redeuil K, Lévêques A, Oberson JM, Bénet S, Tissot E, Longet K, de Castro A, Romagny C, Beauport L, Fumeaux CJF, 2021: Vitamins and carotenoids in human milk delivering preterm and term infants: Implications for preterm nutrient requirements and human milk fortification strategies. Clin Nutr, 40, 222-228.
91. Rigo J, Pieltain C, Salle B, Senterre JJ, 2007: Enteral calcium, phosphate and vitamin D requirements and bone mineralization in preterm infants. Pediatr Res, 96, 969-974.
92. Sabatier M, Garcia-Rodenas CL, De Castro CA, Kastenmayer P, Vigo M, Dubascoux S, Andrey D, Nicolas M, Richoz Payot J, Bordier V, 2019: Longitudinal changes of mineral concentrations in preterm and term human milk from lactating Swiss women. Nutrients, 11, 1855.
93. Sabel KG, Lundqvist-Persson C, Bona E, Petzold M, Strandvik B, 2009: Fatty acid patterns early after premature birth, simultaneously analysed in mothers’ food, breast milk and serum phospholipids of mothers and infants. Lipids Health Dis, 8, 1-15.
94. Schouten E, Haupt J, Ramirez J, Sillett N, Nielsen C, Clarke A, Matkin L, Joseph A, Been J, Bolaños González IJ, 2022: Standardized outcome measures for preterm and hospitalized neonates: An ICHOM standard set. J Neonatal Nurs, 119, 443-454.
95. Sindi AS, Stinson LF, Lai CT, Gridneva Z, Leghi GE, Netting MJ, Wlodek ME, Muhlhausler BS, Zhou X, Payne MS, Geddes DT, 2025: Human milk lactoferrin and lysozyme concentrations vary in response to a dietary intervention. J Nutr Biochem, 135, 109760.
96. Singhal A, 2016: The role of infant nutrition in the global epidemic of non-communicable disease. Proc Nutr Soc, 75, 162-168.
97. Smith SL, Rouse CA, 2017: Docosahexaenoic acid and the preterm infant. Maternal Health Neonatology Perinatol, 3, 1-8.
98. Souza G, Dolinsky M, Matos A, Chagas C, Ramalho A, 2015: Vitamin A concentration in human milk and its relationship with liver reserve formation and compliance with the recommended daily intake of vitamin A in pre-term and term infants in exclusive breastfeeding. Arch Gynecol Obstet, 291, 319-325.
99. Sprenger N, Tytgat HLP, Binia A, Austin S, Singhal A, 2022: Biology of human milk oligosaccharides: From basic science to clinical evidence. J Hum Nutr Diet, 35, 280-299.
100. Sudarma V, Sunardi D, Marzuki NS, Munasir Z, Asmarinah, Hidayat A, Hegar B, 2023: Human milk oligosaccharide profiles and the Secretor and Lewis gene status of Indonesian lactating mothers. Pediatr Gastroenterol Hepatol Nutr, 26, 266-276.
101. Tikanoja T, Simell O, Viikari M, Järvenpää A, 1982: Plasma amino acids in term neonates after a feed of human milk or formula: II. Characteristic changes in individual amino acids. Acta Paediatr, 71, 391-397.
102. Trugo N, Donangelo C, Koury J, Silva M, Freitas L, 1988: Concentration and distribution pattern of selected micronutrients in preterm and term milk from urban Brazilian mothers during early lactation. Eur J Clin Nutr, 42, 497-507.
103. Underwood MA, 2013: Human milk for the premature infant. Pediatr Clin North Am, 60, 189-207.
104. Ureta-Velasco N, Keller K, Escuder-Vieco D, Fontecha J, Calvo MV, Megino-Tello J, Serrano JCE, Romero Ferreiro C, García-Lara NR, Pallás-Alonso CR, 2023: Human milk composition and nutritional status of omnivore human milk donors compared with vegetarian/vegan lactating mothers. Nutrients, 15, 1855.
105. Van Sadelhoff JH, Mastorakou D, Weenen H, Stahl B, Garssen J, Hartog A, 2018: Differences in levels of free amino acids and total protein in human foremilk and hindmilk. Nutrients, 10, 1828.
106. Van Sadelhoff JH, Wiertsema SP, Garssen J, Hogenkamp A, 2020: Free amino acids in human milk: A potential role for glutamine and glutamate in the protection against neonatal allergies and infections. Front Immunol, 11, 1007.
107. Vlachou M, Kyrkou GA, Vivilaki V, Georgakopoulou VE, Katsaounou P, Kapetanaki A, Diamanti A, Kapetanaki A, 2024: Tobacco smoke exposure and lactation. Cureus, 16.
108. Winiarska-Mieczan A, 2014: Cadmium, lead, copper and zinc in breast milk in Poland. Biol Trace Elem Res, 157, 36-44.
109. Xie L, Innis SM, 2008: Genetic variants of the FADS1 FADS2 gene cluster are associated with altered (n-6) and (n-3) essential fatty acids in plasma and erythrocyte phospholipids in women during pregnancy and in breast milk during lactation. J Nutr, 138, 2222-2228.
110. Xu Y, Wang Y, He J, Zhu W, 2022: Antibacterial properties of lactoferrin: A bibliometric analysis from 2000 to early 2022. Front Microbiol, 13.
111. Yurttutan S, Öncel MY, 2023: Prematüre bebeğin enteral beslenmesi. Forbes J Med, 4.
112. Zhang Z, Adelman AS, Rai D, Boettcher J, Lönnerdal B, 2013: Amino acid profiles in term and preterm human milk through lactation: A systematic review. Nutrients, 5, 4800-4821.
113. Zou XQ, Guo Z, Huang JH, Jin QZ, Cheong LZ, Wang XG, Xu XB, 2012: Human milk fat globules from different stages of lactation: A lipid composition analysis and microstructure characterization. J Agric Food Chem, 60, 7158-7167.