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Nutr Rev. 2019 May 21. pii: nuz019. doi: 10.1093/nutrit/nuz019. [Epub ahead of print]

Reviewing the evidence on breast milk composition and immunological outcomes.

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Institute of Agrochemistry and Food Technology, National Research Council (IATA-CSIC), Valencia, Spain.
World Universities Network (WUN), New York, New York, United States.
Department of Immunology, Danone Nutricia Research, Utrecht, the Netherlands.
Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands.
Paediatric Infectious Diseases Research Group, St George's University of London, London, United Kingdom.
Imperial College London, London, United Kingdom.
Public Health England, Porton Down, United Kingdom, and the MRC Unit, Fajara, Gambia.
Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands.
University of Southampton, Southampton, UK.
Department of Clinical and Experimental Medicine, Section of Paediatrics, University of Pisa, Pisa, Italy.
School of Molecular Sciences, the University of Western Australia, Perth, Australia.
Department of Pediatrics, Department of Obstetrics & Gynecology, Faculty of Medicine & Dentistry, School of Public Health, University of Alberta, Alberta, Canada.
National Institute for Health Research, Collaboration for Leadership in Applied Health Research and Care for NW London, London, United Kingdom.
Department of Pediatrics, Sechenov University, Moscow, Russia.
Solov'ev Research and Clinical Center for Neuropsychiatry, Moscow, Russia.


A large number of biologically active components have been found in human milk (HM), and in both human and animal models, studies have provided some evidence suggesting that HM composition can be altered by maternal exposures, subsequently influencing health outcomes for the breastfed child. Evidence varies from the research studies on whether breastfeeding protects the offspring from noncommunicable diseases, including those associated with immunological dysfunction. It has been hypothesized that the conflicting evidence results from HM composition variations, which contain many immune active molecules, oligosaccharides, lactoferrin, and lysozyme in differing concentrations, along with a diverse microbiome. Determining the components that influence infant health outcomes in terms of both short- and long-term sequelae is complicated by a lack of understanding of the environmental factors that modify HM constituents and thereby offspring outcomes. Variations in HM immune and microbial composition (and the differing infantile responses) may in part explain the controversies that are evidenced in studies that aim to evaluate the prevalence of allergy by prolonged and exclusive breastfeeding. HM is a "mixture" of immune active factors, oligosaccharides, and microbes, which all may influence early immunological outcomes. This comprehensive review provides an in-depth overview of existing evidence on the studied relationships between maternal exposures, HM composition, vaccine responses, and immunological outcomes.


antibiotics; breast milk; human milk; immune active molecules; immunological outcomes; microbiome; oligosaccharides; vaccine response


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