Estudio transversal para determinar la relación entre el estado nutricional antropométrico de un grupo de mujeres lactantes de Medellín y el perfil de ácidos grasos de su leche materna madura
DOI:
https://doi.org/10.14306/renhyd.24.4.797Palabras clave:
Leche Humana, Ácidos Grasos, Glándulas Mamarias Humanas, Antropometría, Índice de Masa Corporal.Resumen
Introducción: Los lípidos de la leche materna (LM) están constituidos por diferentes ácidos grasos (AG) de vital importancia para el bebé. El contenido y tipo de AG de la leche humana puede variar según las reservas de grasa maternas. El propósito de este estudio fue determinar la relación entre el estado nutricional antropométrico de un grupo de mujeres lactantes y el perfil de AG de su LM madura.
Material y métodos: El estudio fue descriptivo, transversal y correlacional. El estado nutricional se evaluó en 50 mujeres sanas, a quienes se les tomó una muestra de LM por extracción manual, con mínimo 1 mes de estar amamantando, residentes en Medellín, utilizando Índice de Masa Corporal (IMC), Circunferencia de Cintura (CC), Circunferencia de Brazo (CB) y Circunferencia de Muslo Medio (CMM). Las muestras de LM fueron analizadas por cromatografía de gases.
Resultados: 26 (52 %) mujeres presentaron IMC entre sobrepeso y obesidad, 36 (72 %) CB > 27,1 cm, 32 (64 %) obesidad central según CC y 28 (56 %) presentó CMM > 50,1 cm. En cuanto a LM, los AG saturados arrojaron el mayor contenido 2,05 (0,77) g/100mL, y en los insaturados predominó el ácido linoléico 0,677 (0,31) g/100mL y sus isómeros 0,97 (0,58) g/100mL. No se encontró correlación significativa (p >0,05) entre IMC y el total de los AG saturados, monoinsaturados, poliinsaturados y grasa, aunque IMC se correlacionó (r = 0,281) con los AG saturados de cadena corta y media de la LM y de igual manera CB (r = 0,308) y CMM (r = 0,298).
Conclusiones: No se encontró correlación entre IMC y perfil de AG.La LM analizada tiene mayor cantidad de AG omega 6 y menor omega 3 respecto a las recomendaciones de ingesta en lactantes y la relación insaturados/saturados fue similar a otros estudios.
Citas
(1) Organización Mundial de la Salud [Internet]. Alimentación del lactante y del niño pequeño. [citado 2018 Ene 27]. Disponible en: https://www.who.int/es/news-room/fact-sheets/detail/infant-and-young-child-feeding
(2) Andreas NJ, Kampmann B, Mehring Le-Doare K. Human breast milk: A review on its composition and bioactivity. Early Hum Dev. 2015 Nov; 91(11):629–35.
(3) Vega S, Gutiérrez R, Radilla C, Radilla M, Ramírez A, Pérez J, et al. La importancia de los ácidos grasos en la leche materna y en las fórmulas lácteas. Grasas y aceites. 2012 Abr-Jun;63(2):131–42.
(4) González HF, Visentin S. Nutrientes y neurodesarrollo: Lípidos. Actualización. Arch Argent Pediatr. 2016 Oct 1; 114(5):472–6.
(5) Ballard O. Human Milk Composition: Nutrients and Bioactive Factors. Pediatr Clin North Am. 2013 Feb; 60(1):49–74.
(6) Innis SM. Impact of maternal diet on human milk composition and neurological development of infants. Am J Clin Nutr. 2014 Mar; 99(3):734–41.
(7) Panagos PG, Vishwanathan R, Penfield-Cyr A, Matthan NR, Shivappa N, Wirth MD, et al. Breastmilk from obese mothers has pro-inflammatory properties and decreased neuroprotective factors. J Perinatol. 2016; 36(4): 284–290.
(8) Chang N, Jung JA, Kim H, Jo A, Kang S, Lee SW, et al. Macronutrient composition of human milk from Korean mothers of full term infants born at 37 – 42 gestational weeks. Nutrition Research and Practice 2015;9(4):433-438.
(9) FAO. Panorama de la Seguridad Alimentaria y Nutricional en América Latina y el Caribe. [Internet]. [citado 2018 Nov 20]; 174 p. 2016. Disponible en: http://iris.paho.org/xmlui/bitstream/handle/123456789/33680/9789253096084-spa.pdf?sequence=1&isAllowed=y
(10) Alcaldía de Medellín, Universidad de Antioquia. Perfil de seguridad alimentaria y nutricional de Medellín y sus corregimientos 2015. Medellín; 2015.226 p.
(11) Determinación del tamaño de muestra. [Internet]. [citado 2018 Nov 22]. Disponible en: https://www.fisterra.com/mbe/investiga/9muestras/9muestras2.asp
(12) Departamento Administrativo Nacional de Estadística DANE. Estadísticas vitales 2015. [Internet]. [citado 2018 Ago 02]. Disponible en: https://www.dane.gov.co/index.php/estadisticas-por-tema/demografia-y-poblacion/nacimientos-y-defunciones
(13) Cruz-Hernandez C, Goeuriot S, Giuffrida F, Thakkar SK, Destaillats F. Direct quantification of fatty acids in human milk by gas chromatography. J Chromatogr A. 2013; 1284:174–9.
(14) Ministerio de Salud y protección social [Internet]. Resolución Numero 8430 de 1993. [Citado 2018 Ene 16].
(15) Ministerio de Salud y protección social [Internet]. Resolución Numero 00002465 de 2016. [Citado 2018 Ene 20].
(16) Lohman TG, Roche AF, Martorell R. Anthropometric standardization reference manual. Abridged editor (IL): Human Kinetics; 1991.
(17) Mäkelä J, Linderborg K, Niinikoski H, et al. Breast milk fatty acid composition differs between overweight and normal weight women: the STEPS Study. Eur J Nutr. 2013 Mar;52(2):727-35.
(18) Martin M, Lassek W, Gaulin S, Evans R, Woo J, Geraghty S, et al. Fatty acid composition in the mature milk of Bolivian foragerhorticulturalists: controlled comparisons with a US sample. Matern Child Nutr. 2012 July ; 8(3):4.
(19) Ministerio de salud y protección social. Manual para la extracción, conservación, transporte y suministro de la leche materna [Internet]. 2014. Disponible en: https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/VS/PP/SNA/Manual-extraccion-conservacion-leche-materna.pdf
(20) Bligh E G, Dyer W J. A rapid method of total lipid extraction and purification. Can J Biochem Physiol. 1959; 37: 911-17.
(21) Wan Z, Wang X, Xu L, Geng Q, Zhang Y. Lipid content and fatty acids composition of mature human milk in rural North China. Br J Nutr. 2010 Mar;103(6):913-6.
(22) Guerra H. Determinación de ácido linoléico conjugado en leche materna [Internet]. Bogotá: Universidad Nacional De Colombia; 2010 [Citado 2018 Nov 09]. Disponible en: http://bdigital.unal.edu.co/2422/1/107413.2010.pdf
(23) Duran S, Masson L. Aporte de ácidos grasos trans, ácido linoléico conjugado y ácido docosahexaenoico, en la grasa de leche materna de nodrizas chilenas. Rev Chil Nutr. 2010 Mar; 37(1): 9-17.
(24) Silencio J, Lara G, Pérez F, Montaño S, Ortiz R, Castro M, et al. Ácidos grasos en el calostro y en la leche madura de mujeres mexicanas. Rev Mex Pediatr 2012; 79(1);5-11.
(25) Daud AZ, Mohd-Esa N, Azlan A, Chan YM. The trans fatty acid content in human milk and its association with maternal diet among lactating mothers in Malaysia. Asia Pac J Clin Nutr. 2013;22(3):431-42.
(26) Álvarez de Acosta T, Cluet I, Rossell M, Valbuena E, Ugueto E, Acosta L. Macronutrientes en la leche madura de madres adolescentes y adultas. Arch Latinoam Nutr. 2013 Mar;63(1):46-52.
(27) Kurniati A, Sunardi D, Sungkar A, Bardosono S, Kartinah N. Associations of maternal body composition and nutritional intake with fat content of Indonesian mothers’ breast milk. Paediatr Indones. 2016 Sep;56(5):297-03.
(28) Van de Heijning B, Stahl B, Schaart M, van der Beek E, Rings E, Mearin L. Fatty acid and amino acid content and composition of human milk in the course of lactation. Adv Pediatr Res. 2017;4:16.
(29) Gidrewicz DA, Fenton TR. A systematic review and meta-analysis of the nutrient content of preterm and term breast milk. Disponible en: BMC Pediatr. 2014 Aug 30;14:216.
(30) Minjarez-Corral M, Rincón-Gómez I, Morales-Chomina Y, Espinosa-Velasco MJ, Zárate A, Hernández-Valencia M. Ganancia de peso gestacional como factor de riesgo para desarrollar complicaciones obstétricas. Perinatol Reprod Hum. 2014 Sep;28(3):159-66.
(31) Rasmussen KM, Kjolhede CL. Prepregnant Overweight and Obesity Diminish the Prolactin Response to Suckling in the First Week Postpartum. Pediatrics. 2004 May; 113 (5):465-71.
(32) Marseglia L, Manti S, D’Angelo G, Cuppari C, Salpietro V, Filippelli M, et al. Obesity and breastfeeding: The strength of association. Women Birth. 2015 Jun; 28(2):81–6.
(33) Sperrin M, Marshall AD, Higgins V, Renehan AG, Buchan IE. Body mass index relates weight to height differently in women and older adults: serial cross-sectional surveys in England (1992-2011). J Public Health (Oxf). 2016 Sep; 38(3):607-13.
(34) Rosário R, Barros R, Padrão P, Santos R, Teixeira VH, Lopes O, et al: Body Mass Index Categories and Attained Height in Portuguese Adults. Obes Facts. 2018;11(4):287-93.
(35) World Health Organization. Body mass index – BMI. [Internet]. WHO. [Citado 2019 Ene 09]. Disponible en: http://www.euro.who.int/en/health-topics/disease-prevention/nutrition/a-healthy-lifestyle/body-mass-index-bmi
(36) Institute of Medicine. Weight gain during pregnancy: reexamining the guidelines [Internet]. IOM. 2009 [Citado 2019 Ene 25]. Disponible en: http://www.nationalacademies.org/hmd/~/media/Files/Report%20Files/2009/Weight-Gain-During-Pregnancy-Reexamining-the-Guidelines/Report%20Brief%20-%20Weight%20Gain%20During%20Pregnancy.pdf
(37) FAO. Energy requirements of lactation. Disponible en: http://www.fao.org/3/y5686e/y5686e0b.htm
(38) Butte NF, King JC. Energy requirements during pregnancy and lactation. Public Health Nutr. 2005 Oct;8(7A):1010–27.
(39) Gilmore LA, Klempel-Donchenko M, Redman LM. Pregnancy as a window to future health: Excessive gestational weight gain and obesity. Semin Perinatol. 2015 Jun;39(4):296-303.
(40) Rode L, Kjærgaard H, Ottesen B, Damm P, Hegaard HK. Association between gestational weight gain according to body mass index and postpartum weight in a large cohort of Danish women. Matern Child Health J. 2012; 16(2):406–13.
(41) Ramon-Arbues E, Abadia BM, Gomez SM. Ganancia de peso gestacional y retención de peso posparto en una cohorte de mujeres en aragón (España). Nutr Hosp. 2017 Oct; 34(5):1138-45
(42) Ma D, Szeto IMY, Yu K, Ning Y, Li W, Wang J, et al. Association between gestational weight gain according to prepregnancy body mass index and short postpartum weight retention in postpartum women. Clin Nutr. 2015 Apr;34(2):291-5.
(43) Nogueira JL, Saunders C, Leal MDC. Anthropometric methods used in the evaluation of the postpartum weight retention: a systematic review. Cien Saude Colet. 2015 Feb;20(2):407-20.
(44) Nguyen P, Ramakrishnan U, Katz B, Gonzalez-Casanova I, Lowe AE, Nguyen H, et al. Mid-upper-arm and calf circumferences are useful predictors of underweight in women of reproductive age in northern Vietnam. Food Nutr Bull. 2014 Sep;35(3):301-11.
(45) World Health Organization. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser. [Internet]. 2000. [Citado 2019 Ene 27]. Disponible en: http://www.who.int/nutrition/publications/obesity/WHO_TRS_894/en/
(46) Tang AM, Dong K, Deitchler M, Chung M, Maalouf-Manasseh Z, Tumilowicz A, et al. Use of Cutoffs for Mid-Upper Arm Circumference (MUAC) as an Indicator or Predictor of Nutritional and Health-Related Outcomes in Adolescents and Adults: A Systematic Review. 2013. Washington, DC: FHI 360/FANTA.
(47) Berdasco Gómez A, Romero del Sol JM. Circunferencia del Brazo como evaluadora del estado nutricional del Adulto. Revista Cubana Aliment Nutr 1998;12(2):86-90.
(48) López LB, Calvo EB, Poy MS, del Valle Balmaceda Y, Cámera K. Changes in skinfolds and mid-upper arm circumference during pregnancy in Argentine women. Matern Child Nutr. 2011 Jul;7(3):253-62.
(49) World Health Organization. WHO. The Harmonised Training Package (HTP): Resource Material for Training on Nutrition in Emergencies. [Internet]. 2011 [Citado 2019 Ene 28]. Disponible en: http://files.ennonline.net/attachments/1979/htp-module-6-whole-module.pdf
(50) Cooley SM, Donnelly JC, Walsh T, Durnea U, Collins C, Rodeck CH, et al. The relationship between body mass index and mid-arm circumference in a pregnant population. J Obstet Gynaecol (Lahore). 2011 Oct;31(7):594-6.
(51) Okereke CE, Anyaehie UB, Dim CC, Iyare EE, Nwagha UI. Evaluation of some anthropometric indices for the diagnosis of obesity in pregnancy in Nigeria: A cross-sectional study. Afr Health Sci. 2013 Dec;13(4):1034-40. PubMed PMID: 24940329; PubMed Central PMCID: PMC4056469.
(52) Paliulyte V, Drasutiene GS, Ramasauskaite D, Bartkeviciene D, Zakareviciene J, Kurmanavicius J. Physiological Uterine Involution in Primiparous and Multiparous Women: Ultrasound Study. Obstet Gynecol Int. 2017;2017:6739345. PubMed PMID: 28555159; PubMed Central PMCID: PMC5438840.
(53) Jung KJ, Kimm H, Yun JE, Jee SH. Thigh Circumference and Diabetes: Obesity as a Potential Effect Modifier. J Epidemiol. 2013 Sep 5;23(5):329-36.
(54) Sundermann AC, Abell TD, Baker LC, Mengel MB, Reilly KE, Bonow MA, et al. The impact of maternal adiposity specialization on infant birthweight: upper versus lower body fat. Eur J Obstet Gynecol Reprod Biol. 2016 Nov; 206:239-44. doi.org/10.1016/j.ejogrb.2016.09.007.
(55) Organización Mundial de la Salud. Lactancia materna [Internet]. OMS. [citado 2019 Feb 02]. Disponible en: https://www.who.int/topics/breastfeeding/es/
(56) Ministerio de Salud y protección social. Encuesta Nacional de la Situación Nutricional en Colombia, ENSIN-2010. [Internet]. [citado 2019 Feb 02]. Disponible en: https://www.icbf.gov.co/sites/default/files/resumenfi.pdf
(57) Alcaldía de Envigado – Secretaría de Salud. Análisis de Situación de Salud Departamento de Antioquia 2016. Secretaría de Salud. [Internet]. [citado 2019 Feb 05]. Disponible en: https://www.envigado.gov.co/secretaria-salud/SiteAssets/010_ACORDEONES/DOCUMENTOS/2018/03/Situaci%C3%B3n%20de%20salud%20%20Envigado%20a%C3%B1o%202016.pdf
(58) Review Female age-related fertility decline. Committee Opinion No. 589. American College of Obstetricians and Gynecologists Committee on Gynecologic Practice and Practice Committee. Fertil Steril. 2014 Mar; 101(3):633-4.
(59) Truchet S, Honvo-Houéto E. Physiology of milk secretion. Best Pract Res Clin Endocrinol Metab. 2017 Aug;31(4):367-384.
(60) López B, Martínez L, Zapata N. Motivos del abandono temprano de la lactancia materna exclusiva: un problema de salud pública no resuelto en la ciudad de Medellín. Rev Salud Publica (Bogota) 2013; 31(1): 117-126.
(61) Logan Ch, Zittel T, Striebel S, Reister F, Brenner H, Rothenbacher D, Genuneit J. Changing Societal and Lifestyle Factors and Breastfeeding Patterns Over Time. Pediatrics. 2016 May;137(5).
(62) Departamento Administrativo Nacional de Estadísticas. Preguntas frecuentes. DANE [Internet] [citado 2019 Feb 4]. Disponible en: https://www.dane.gov.co/files/geoestadistica/Preguntas_frecuentes_estratificacion.pdf
(63) Álvarez-Castaño L, Goez-Rueda J, Carreño-Aguirre C. Factores sociales y económicos asociados a la obesidad: los efectos de la inequidad y de la pobreza. 2012. Rev. Gerenc. Polit. Salud, 11 (23): 98-110.
(64) Virginie de Halleux, Jacques Rigo; Variability in human milk composition: benefit of individualized fortification in very-low-birth-weight infants. Am J Clin Nutr. 2013 Aug 1; 98(2):529–35.
(65) Hassiotou F, Hepworth AR, Williams TM, Twigger AJ, Perrella S, Lai CT, et al. Breastmilk cell and fat contents respond similarly to removal of breastmilk by the infant. PLoS One 2013 Nov;8(11):e78232.
(66) Khan S, Hepworth AR, Prime DK, Lai CT, Trengove NJ, Hartmann PE. Variation in Fat, Lactose, and Protein Composition in Breast Milk over 24 Hours: Associations with Infant Feeding Patterns. J Hum Lact. 2013 Feb;29(1):81–9.
(67) Kent J, Gardner H, Lai Ch, Hartmann P, Murray K, Rea A, Geddes D. Hourly Breast Expression to Estimate the Rate of Synthesis of Milk and Fat. Nutrients. 2018 Aug 22;10(9).
(68) Mäkelä J, Linderborg K, Niinikoski H, et al. Breast milk fatty acid composition differs between overweight and normal weight women: the STEPS Study. Eur J Nutr. 2013 Mar;52(2):727-35.
(69) Asociación Española de Pediatria. Decálogo sobre las grasas en la alimentación de niños y adolescentes [Internet]. AEPED. 2014 [citado 2019 Feb 6]. Disponible en: https://www.aeped.es/comite-nutricion/documentos/decalogo-sobre-las-grasas-en-alimentacion-ninos-y-adolescentes
(70) Sinanoglou VJ, Cavouras D, Boutsikou T, Briana DD, Lantzouraki DZ, et al. Factors affecting human colostrum fatty acid profile: A case study. PLoS One. 2017 Apr 14;12(4):e0175817.
(71) Nasser R, Stephen AM, Goh YK, Clandinin MT. The effect of controlled manipulation of maternal dietary fat intake on medium and long-chain fatty acids in human breast milk in Saskatoon, Canada. Int Breastfeeding J. 2010 Feb 19;5:3. PubMed PMID: 20170476; PubMed Central PMCID: PMC2838825.
(72) McManaman JL. Lipid transport in the lactating mammary gland. J Mammary Gland Biol Neoplasia. 2014 Mar; 19(1): 35–42.
(73) Gropper S, Smith J. Lipids In: Sareen S, ed. Advanced nutrition and human metabolism. 6 ed. Belmont: Wadsworth Cengage Learning; 2013.
(74) Mohammad MA, Haymond MW. Regulation of lipid synthesis genes and milk fat production in human mammary epithelial cells during secretory activation. Am J Physiol Endocrinol Metab. 2013 Sep;305(6):E700-16.
(75) Rudolph MC, McManaman JL, Phang T, Russell T, Kominsky DJ, Serkova NJ, et al. Metabolic regulation in the lactating mammary gland: a lipid synthesizing machine. Physiol Genomics. 2007 Feb 12;28(3):323-36.
(76) German, J. B., Dillard, C. J. Saturated fats: a perspective from lactation and milk composition. Lipids. 2010 Oct;45(10):915-23.
(77) Mendonça MA, Araújo W, Borgo LA, Alencar ER. Lipid profile of different infant formulas for infants. PloS One. 2017;12(6):e0177812. doi:10.1371/journal.pone.0177812
(78) Delplanque B, Gibson R, Koletzko B, Lapillonne A, Strandvik B. Lipid Quality in Infant Nutrition: Current Knowledge and Future Opportunities. J Pediatr Gastroenterol Nutr. 2015 Jul;61(1):8-17.
(79) Greta Krešić, Mihela Dujmović, Milena Mandić, Ivančica Delaš. Relationship between Mediterranean diet and breast milk fatty acid profile: a study in breastfeeding women in Croatia. Dairy Sci Technol. 2013;93(3):287-301.
(80) Dussaillant C, Echeverría G, Urquiaga I, Velasco N, Rigotti A. Evidencia actual sobre los beneficios de la dieta mediterránea en salud. Rev Med Chile. 2016;144:1044-1052.
(81) Abrahamse E, Minekus M, Van Aken GA, Van de Heijning B, Knol J, Bartke N, et al. Development of the Digestive System-Experimental Challenges and Approaches of Infant Lipid Digestion. Food Dig. 2012 Dec;3(1-3):63-77.
(82) Knez M, Stangoulis J, Glibetic M, Tako E. The Linoleic Acid: Dihomo-γ-Linolenic Acid Ratio (LA:DGLA)—An Emerging Biomarker of Zn Status. Nutrients. 2017 Aug;9(8):825.
(83) Hadley K, B Ryan, Forsyth A, Gautier S, Salem N. The Essentiality of Arachidonic Acid in Infant Development. Nutrients. 2016 Apr;8(4):216.
(84) Institute of Medicine. Dietary Reference Intakes Tables and Application [Internet]. IOM. 2011. [citado 2019 Feb 10]. Disponible en: http://nationalacademies.org/hmd/~/media/Files/Activity%20Files/Nutrition/DRI-Tables/8_Macronutrient%20Summary.pdf?la=en
(85) M Gil-Campos, Dalmau SJ, Comité de Nutrición de la Asociación Española de Pediatría. Importancia del ácido docosahexaenoico (DHA): funciones y recomendaciones para su ingesta en la infancia. An Pediatr (Barc). 2010;73(3):142.e1–142.e8.
(86) Morales P J, Valenzuela B R, González M D, González E M, Tapia O G, Sanhueza C J, et al. Nuevas fuentes dietarias de ácido alfa-linolénico: una visión crítica. Rev Chil Nutr. 2012;39(3):79–87.
(87) Gibson RA, Muhlhausler B, Makrides M. Conversion of Linoleic Acid and Alpha-Linolenic Acid to Long-Chain Polyunsaturated Fatty Acids (LCPUFAs), with a Focus on Pregnancy, Lactation and the First 2 Years of Life. Matern Child Nutr. 2011 Apr; 7, 17-26.
(88) Liu JJ, Green P, John Mann J, Rapoport SI, Sublette ME. Pathways of polyunsaturated fatty acid utilization: implications for brain function in neuropsychiatric health and disease. Brain Res. 2014 Feb 9; 1597:220-46.
(89) European Food Safety Authority. Scientific Opinion on nutrient requirements and dietary intakes of infants and young children in the European Union. EFSA J 2013;11(10):3408,103p. Disponible en: doi:10.2903/j.efsa.2013.3408
(90) Aumeistere L, Ciproviča I, Zavadska D, Volkovs V. Fish intake reflects on DHA level in breast milk among lactating women in Latvia. Int Breastfeed J. 2018 Jul 20;13:33.
(91) Huffman SL, Harika RK, Eilander A, Osendarp SJM. Essential fats: how do they affect growth and development of infants and young children in developing countries? A literature review. Matern Child Nutr. 2011 Oct 1;7(s3):44–65.
(92) Demmelmair H, Koletzko B. Lipids in human milk. Best Pract Res Clin Endocrinol Metab. 2018;32(1):57-68.
(93) Czosnykowska-Łukacka M, Królak-Olejnik B, Orczyk-Pawiłowicz M. Breast Milk Macronutrient Components in Prolonged Lactation. Nutrients. 2018 Dec 3;10(12):1893.
(94) Storck Lindholm E, Strandvik B, Altman D, Möller A, Palme Kilander C. Different fatty acid pattern in breast milk of obese compared to normal-weight mothers. Prostaglandins Leukot Essent Fatty Acids. 2013 Mar;88(3):211-7.
(95) Elliott SA, Pereira LR, Guigard E, McCargar LJ, Bell RC, Prado CM. Lactation, Weight Retention and Body Composition at 3 Months Postpartum: Is There a Link?. Can J Diabetes. 2015 Apr 1; 39: S57.
(96) Widen E, Whyatt R, Hoepner L, Ramirez-Carvey J, Oberfield S, Hassoun A, et al. Excessive gestational weight gain is associated with long-term body fat and weight retention at 7 y postpartum in African American and Dominican mothers with underweight, normal, and overweight prepregnancy BMI. Am J Clin Nutr. 2015 Dec 1;102(6):1460-67.
(97) Vidakovic A, Jaddoe V, Gishti O, Felix J, Williams M, Hofman A, et al. Body mass index, gestational weight gain and fatty acid concentrations during pregnancy: the Generation R Study. Eur J Epidemiol. 2015;30(11): 1175-85.
(98) Fujimori M, França E, Fiorin V, Morais T, Honorio-França A, Abreu L. Changes in the biochemical and immunological components of serum and colostrum of overweight and obese mothers. BMC Pregnancy and Childbirth. 2015;15:166.
(99) Ortiz B, De León L, Carrasco C. Indicadores antropométricos y su relación con marcadores bioquímicos en mujeres. Nutr Hosp. 2015;32(6):2547-50.
(100) Mahmoud A. Mohammad, Agneta L. Sunehag, Morey W. Haymond. De novo synthesis of milk triglycerides in humans. Am J Physiol Endocrinol Metab. 2014 Apr 1; 306(7):E838–E847.
(101) Saben JL, Bales ES, Jackman MR, Orlicky D, MacLean PS, McManaman JL Maternal Obesity Reduces Milk Lipid Production in Lactating Mice by Inhibiting Acetyl-CoA Carboxylase and Impairing Fatty Acid Synthesis. PLoS One. 2014;9(5):e98066.
(102) Sosa-Castillo E, Rodríguez-Cruz M, Moltó-Puigmartí C. Genomics of lactation: role of nutrigenomics and nutrigenetics in the fatty acid composition of human milk. Br J Nutr. 2017;118(3):161–8.