母乳中的營養成份有三個來源:由分泌母乳的乳腺细胞(lactocytes)製造、從母親飲食中攝取、母親體內的儲備。

母乳中的常量營養素(macronutrients)及熱量成份

常量營養素包括蛋白質、脂肪、碳水化合物(乳糖)。

「早產嬰兒母親」母乳跟「足月嬰兒母親」母乳的常量營養素成份有別。早產嬰兒母親的母乳一般的蛋白質及脂肪含量較高。

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母乳產量多的母親,乳汁的脂肪和蛋白質含量往往較低,但乳糖的含量則較高[1]

蛋白質

母乳中的蛋白質可分為兩大類,乳清(whey)及酪蛋白(casein)[2],[3]。含量最多的蛋白質有酪蛋白、α乳白蛋白(α-lactalbumin)、乳鐵蛋白(lactoferrin)、分泌型免疫球蛋白A(secretory IgA)、溶菌酶(lysozyme)及血清白蛋白(serum albumin)[4],[5]。 「早產嬰兒母親」 的母乳較 「足月嬰兒母親」的含有更豐富的蛋白質(見表1)。然而,無論嬰兒是足月或早產,所有母親母乳中的蛋白質,在嬰兒出生4至6週後,會慢慢減少[6],但蛋白質的含量不會受母親的飲食習慣影響。體重與身高比例較高的母親,她們的乳汁具有更多的蛋白質,但母乳產量多的母親,她們母乳中蛋白質的含量却反而較少[7]

脂肪

母乳中的脂肪,主要為棕櫚酸(palmitic acid)及油酸(oleic acid)。 在所有主要營養素中,脂肪的成份在母乳中改變最大。在哺餵後段的奶稱為後段奶(hindmilk)。它們的乳脂濃度比哺餵初期的乳汁 ,又稱為初段奶(foremilk)高出兩至三倍[8]

母乳中的脂肪酸成份,特別是長鏈多元不飽和脂肪酸(LCPUFAs),取決於母親的飲食習慣。西方飲食文化偏向於攝取ω-6脂肪酸(omeag-6 fatty acids),而吸收ω-3脂肪酸(omeag-3 fatty acids)的機會則較少。二十二碳六烯酸(DHA)在北美人口的母乳中特別偏低[9],[10],[11]

乳糖

乳糖是母乳中主要的糖分。在母乳中,其濃度改變在所有常量營養素中改變最少。不過,母乳產量多的母親,往往能提供乳糖濃度更高的母乳[1]

微量營養素

雖然母乳被公認為是嬰兒營養的標準典範,不過, 多種微量元素,如維生素A、B1、B2、B6、B12、D  及碘的成份,則會因母親的飲食習慣及體內儲備而有所變化。

全球產婦普遍接觸陽光的時間越來越少,這會進一步减少母乳中維生素D的含量[12]。雖然產婦服用維生素D補充劑對母乳成份的影響尚未清楚,建議用母乳喂育嬰兒的母親仍應服用維生素D 補充劑[7],[8],[13]

 
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[2] Liao Y, Alvarado R, Phinney B, et al. Proteomic characterization of human milk whey proteins during a twelve-month lactation period. J Proteome Res 2011; 10(4):1746–54.
[3] Gao X, McMahon RJ, Woo JG, et al. Temporal changes in milk proteomes reveal developing milk functions. J Proteome Res 2012;11(7):3897–907.
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[6] Bauer J, Gerss J. Longitudinal analysis of macronutrients and minerals in human milk produced by mothers of preterm infants. Clin Nutr 2011;30(2):215–20.
[7] Nommsen LA, Lovelady CA, Heinig MJ, et al. Determinants of energy, protein, lipid, and lactose concentrations in human milk during the first 12 mo of lactation: the DARLING Study. Am J Clin Nutr 1991;53(2):457–65.
[8] Saarela T, Kokkonen J, Koivisto M. Macronutrient and energy contents of human milk fractions during the first six months of lactation. Acta Paediatr 2005;94(9): 1176–81.
[9] Valentine CJ, Morrow G, Fernandez S, et al. Docosahexaenoic acid and amino acid contents in pasteurized donor milk are low for preterm infants. J Pediatr 2010;157(6):906–10.
[10] Valentine CJ, Morrow G, Pennell M, et al. Randomized controlled trial of docosahexaenoic acid supplementation in midwestern U.S. Human milk donors. Breastfeed Med 2012. http://dx.doi.org/10.1089/bfm.2011.0126.
[11] Martin MA, Lassek WD, Gaulin SJ, et al. Fatty acid composition in the mature milk of Bolivian forager-horticulturalists: controlled comparisons with a US sample. Matern Child Nutr 2012;8(3):404–18.
[12] Dawodu A, Zalla L, Woo JG, et al. Heightened attention to supplementation is needed to improve the vitamin D status of breastfeeding mothers and infants when sunshine exposure is restricted. Matern Child Nutr 2012. http://dx.doi.org/10.1111/j.1740-8709.2012.00422.x.
[13] American Academy of Pediatrics. Pediatric nutrition handbook. 6th edition. Elk Gove Village (IL): American Academy of Pediatrics; 2009.