Mother's Milk: Defining the Critical Questions

In January of this year Peggy Neville, Jim McManaman, and Steve Anderson organized and hosted a small conference “designed to bring together a number of different folks in the areas of lactation, breastfeeding, milk, and neonatal nutrition to try to define the critical research questions in these fields.”  During those three unusually balmy days in Denver, Colorado we discussed not just our research programs and findings to date, but explicitly identified unresolved questions in lactation biology and established future goals for research.  

The outcome of those discussions was synthesized in a paper out this week from the Journal of Mammary Gland Biology and Neoplasia entitled “Lactation and NeonatalNutrition: Defining and Refining the Critical Questions”. And best of all that paper is open access! 

In this paper we discuss the current state of knowledge, reviewing a substantial amount of the lactation biology literature. From that foundational framing, we identify the next steps in unlocking mother’s milk and the impact on infant outcomes. The use of animal models and targeting research in at-risk human populations are discussed in detail, as are training programs for the next generation of lactation biologists. These topics and areas of future research effort are critically important for improving human health, nutrition, and development.

Now, if reading 18 pages of an academic paper isn’t what you consider a party, I have provided some of the key research targets below:

Topic I. MILK COMPONENTS AND THEIR FUNCTION

Specific Research Target:  A complete analysis of the structure and concentration of human milk components, as well as factors influencing their variability among women and throughout lactation.

Specific Research Target:  A detailed understanding of the functional mechanisms by which milk components acting individually and in concert, promote intestinal maturation, protect against infection, and stimulate immune development in the infant.

Specific Research Target: Compile a complete database of commonly used therapeutic drugs that includes their rate of secretion into milk as well as effects on infant health and development.

Topic II. EFFECTS OF MILK ON BEHAVIORAL DEVELOPMENT

Specific Research Target: Determine the effects of specific and interaction components of milk on brain development and behavioral phenotype.

Kathy West/CNPRC

Topic III. MATERNAL FACTORS AFFECTING  VOLUME & COMPOSITION

Specific Research Topic: A mechanistic understanding of the factors and signaling pathways that regulate mammary differentiation in late pregnancy, at parturition, and during lactation.

Specific Research Topic: Identify the genetic and epigenetic basis for heritable maternal traits related to lactation success.

Madonna Litta, Leonardo da Vinci, 1490-91

Specific Research Topic: Generate a fundamental understanding of the biological and psychological causes of inadequate lactation performance including delayed onset of lactation and consistent low production.

Specific Research Topic: Carefully controlled studies in humans and relevant animal models to dissect the effects of nutrition, maternal adiposity, and metabolic disease on lactation performance.

Topic IV: BREASTFEEDING AND THE AT-RISK NEONATE

Specific Research Topic: A comprehensive understanding of the components of human milk responsible for reducing the risk of morbidities for preterm infants, the mechanisms by which they act, and how they are affected by common NICU practices for collecting, storing, handling, and feeding human milk.

Specific Research Target: Understanding the mechanisms by which breastfeeding modifies the fetal programming of infants at risk for metabolic disease as adults.

Specific Research Target: Conduct clinical studies in at-risk populations who may have low socio-economic status, poor health, poor nutrition to prevent/ameliorate lactation failure and growth stunting.

Topic V. Training the Future Lactation Biologist

Education Target: New programs and resources to repopulate the diminishing pool of lactation biologists and promote communication between the diverse disciplines required to understand milk, its secretion, and its effects on the neonate.

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Further Reading:

Neville MC, Anderson SM, McManaman, Badger TM, Bunik M, Crume T, Dabelea D, Donovan S, Forman N,  Frank DN, Friedman JE, German JB, Goldman A, Hadsell D, Hambidge M, Hinde K, Horseman ND, Hovey RC, Hovey RC, Janoff E, Krebs N, Lebrilla C, Lemay DG, MacLean PS, Meier P, Morrow A, Neu J, Nommsen-Rivers, Raiten DJ, Rijnkels M, Seewaldt V, Shur BD, VanHouten J, Williamson P. 2012. Lactation and neonatal nutrition: defining and refining the critical questions. Journal of Mammary Gland Biology and Neoplasia. Early View: DOI: 10.1007/s10911-012-9261-5