Authors
Krysten North, Sophie Driker, Rasheda Khanam, Salahuddin Ahmed, Chloe Andrews, Mandy B Belfort, Sara Cherkerzian, Nabidul H Chowdhury, Tarik Hasan, Sayedur Rahman, Unmesha Roy Paladhi, Amy Lopez Esteban, Carmen Monthe-Dreze, Fahmida Tofail, Abdullah Baqui, Sarbattama Sen, Anne Cc Lee
Published in
Current developments in nutrition. Volume 10. Issue 10. Pages 109531. Epub Sep 16, 2026.
Abstract
Limited data exist on the relationship between breast milk macronutrient/energy concentrations and child outcomes in settings with high maternal undernutrition.
This study aims to determine associations of breast milk macronutrient (protein, fat, carbohydrate) and energy concentrations with child growth and neurodevelopment.
In this observational lactation cohort of 99 mother-infant dyads from Sylhet, Bangladesh, mothers provided hand-expressed breast milk samples at 2 and 5 mo postpartum. Infant anthropometrics were obtained at birth, 3, 6, 12, and 24 mo; neurodevelopment was assessed at 24 mo using the Bayley Scales of Infant and Toddler Development-III. Macronutrient concentrations were measured using midinfrared spectroscopy. Associations with growth and neurodevelopment z-scores were estimated using mixed models and linear regression, adjusted for a priori confounders. Primary outcomes were length-for-age z-score (12 mo) and cognitive z-scores (24 mo) in relation to 2-mo protein concentration.
Breast milk samples were provided at 2 (n = 98) and 5 mo (n = 87). We found no significant associations between 2-mo protein and 12-mo length-for-age z-scores or 24-mo cognitive z-scores. Higher 2-mo fat (g/dL) was associated with lower weight-for-age z-scores at 3 mo [b: -0.12 (95% confidence interval (CI): -0.24, -0.005)] and lower head circumference-for-age z-scores at 3 [-0.20 (-0.32, -0.09)], 6 [-0.19 (-0.31, -0.08)], and 12 mo [-0.17 (-0.29,-0.06)]. Similarly, 2-mo energy (kcal/dL) was inversely associated with 3-mo weight-for-age z-scores [-0.01 (-0.03, -0.001)] and head circumference-for-age z-scores at 3 [-0.02 (-0.04, -0.01)], 6 [-0.02 (-0.03, -0.01)], and 12 mo [-0.02 (-0.03, -0.01)]. Higher 2-mo carbohydrate (g/dL) was associated with higher motor z-scores [1.08 (0.06, 2.09)], and higher 5-mo carbohydrate with higher cognitive z-scores [1.10 (0.15, 2.05)].
Protein concentrations were not associated with linear or cognitive outcomes in this cohort. Our findings suggest that future studies targeting infant outcomes may optimally be designed to account for factors beyond macronutrient concentration, such as daily milk volume intake, that may impact infant growth and development.
PMID:
42893190
Bibliographic data and abstract were imported from PubMed on 18 Oct 2026.
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