Accessible Requires Authentication Published by De Gruyter August 29, 2018

Are breast milk adipokines affected by maternal dietary factors?

Betül Kocaadam, Eda Köksal and Canan Türkyılmaz



Maternal diet and gestational age of infant may affect the composition of breast milk. The aim of this study was to evaluate the relationship between breast milk adiponectin and leptin levels of mothers delivering preterm and term infants and maternal diet.


Sixty-five mothers (31 preterm, 34 term) were included in the study. General information about parents and infants and food consumption of mothers were determined through a questionnaire. Milk samples were taken from mothers during the period between the 15th and 30th day after birth (mature milk). For the evaluation of maternal diet, the nutrient adequacy ratio (NAR) and mean adequacy ratio (MAR) were used.


According to MAR, 71.0% of preterm mothers’ and 79.4% of term mothers’ dietary adequacy was categorized as “good”, and none of the mothers fell into the “insufficient” category (p>0.05). The median (interquartile range [IQR]) level of adipokines was found to be higher in preterm than in term mothers (24.6 [14.3] ng/mL; 22.9 [9.7] ng/mL for adiponectin and 2.0 [2.5] ng/mL; 0.0 [2.3] ng/mL for leptin, respectively) (p>0.05). A negative correlation was found between the leptin level and intake of unsaturated fatty acids, protein NAR and meat, poultry and fish consumption in preterm mothers (p<0.05). A positive correlation was found between leptin concentration and MAR, protein, calcium, potassium NAR and consumption of dairy products in term mothers (p<0.05). In the regression model, gestational age and MAR are important predictors of leptin.


These results show that maternal diet is related to the leptin content in breast milk.

Corresponding author: Betül Kocaadam, MSc, Gazi University Faculty of Health Sciences, Department of Nutrition and Dietetics, Emniyet Mah. Muammer Yaşar Bostancı, Cad. No. 16 06560 Beşevler, Ankara, Turkey


We are grateful to all the mothers who participated in this cohort study.

  1. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: Betül Kocaadam was supported by a research grant from ÖYP. ÖYP is the abbreviation for the Faculty Development Programme established to train academicians.

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

  6. Conflict of interest statement: The authors declare that they have no conflicts of interest.


1. Arlı M, Şanlıer N, Küçükkömürler S, Yaman M. Anne ve çocuk beslenmesi (Dördüncü baskı) [Maternal and child nutrition, 4th ed.]. Ankara, Turkey: Pegem Akademi (Turkey), 2012:115–7. Search in Google Scholar

2. Allen HA. Maternal nutrient metabolism and requirements in pregnancy and lactation. In Erdman JW, Macdonald IA, Zeisel SH, editors. Present knowledge in nutrition, 10th ed. Ames, Iowa: Wiley-Blackwell, 2012:608–24. Search in Google Scholar

3. Köksal G, Gökmen H. Çocuk hastalıklarında beslenme tedavisi (Birinci baskı) [Nutritional treatment in childhood diseases, 1st ed.]. Ankara, Turkey: Hatipoğlu Yayınları (Turkey), 2000:67–95. Search in Google Scholar

4. Karaağaoğlu N, Eroğlu Samur G. Anne ve çocuk beslenmesi (Dördüncü Baskı) [Maternal and child nutrition, 4th ed.]. Ankara, Turkey: Pegem Akademi (Turkey), 2015:50–9. Search in Google Scholar

5. Bauer J, Gerss J. Longitudinal analysis of macronutrients and minerals in human milk produced by mothers of preterm infants. Clin Nutr 2011;30:215–20. Search in Google Scholar

6. Castellote C, Casillas R, Ramirez-Santana C, Pérez-Cano FJ, Castell M, et al. Premature delivery influences the immunological composition of colostrum and transitional and mature human milk. J Nutr 2011;141:1181–7. Search in Google Scholar

7. Kociszewska-Najman B, Borek-Dzieciol B, Szpotanska-Sikorska M, Wilkos E, Pietrzak B, et al. The creamatocrit, fat and energy concentration in human milk produced by mothers of preterm and term infants. J Matern Fetal Neonatal Med 2012;25:1599–602. Search in Google Scholar

8. Gidrewicz DA, Fenton TR. A systematic review and meta-analysis of the nutrient content of preterm and term breast milk. BMC Pediatr 2014;14:216. Search in Google Scholar

9. Karatas Z, Durmus Aydogdu S, Dinleyici EC, Colak O, Dogruel N. Breast milk ghrelin, leptin, and fat levels changing foremilk to hindmilk: is that important for self-control of feeding? Eur J Pediatr 2011;170:1273–80. Search in Google Scholar

10. Erick M. Nutrition in pregnancy and lactation. In: Kathleen Mahan L, Escott-Stump S, Raymond JL, editors. Krause’s food and the nutrition care process, 13th ed. USA: Saunders, 2012:365–70. Search in Google Scholar

11. Savino F, Liguori SA, Lupica MM. Adipokines in breast milk and preterm infants. Early Hum Dev 2010;86:77–80. Search in Google Scholar

12. Bebis Nutrition Data Base Software. The German Food Code and Nutrient Data Base (BLS II.3, 1999) with additions from USDA-sr and other sources, Istanbul, Turkey, 2004. Search in Google Scholar

13. Mirmiran P, Azadbakht L, Esmaillzadeh A, Azizi F. Dietary diversity score in adolescents – a good indicator of the nutritional adequacy of diets: Tehran lipid and glucose study. Asia Pac J Clin Nutr 2004;13:56–60. Search in Google Scholar

14. Bronsky J, Karpisek M, Bronska E, Pechová M, Jancíková B, et al. Adiponectin, adipocyte fatty acid binding protein, and epidermal fatty acid binding protein: proteins newly identified in human breast milk. Clin Chem 2006;52:1763–70. Search in Google Scholar

15. Catli G, Olgac Dundar N, Dundar BN. Adipokines in breast milk: an update. J Clin Res Pediatr Endocrinol 2014;6:192–201. Search in Google Scholar

16. Huang J, Vaughn MG, Kremer KP. Breastfeeding and child development outcomes: an investigation of the nurturing hypothesis. Matern Child Nutr 2016;12:757–67. Search in Google Scholar

17. Aydın İ, Özgürtaş T, Turan Ö, Koc E, Hirfanoglu IM, et al. Biochemical comparison of preterm and term newborn’s mother’s milk. Turk J Biochem 2009;34:242–9. Search in Google Scholar

18. Savino F, Liguori SA. Update on breast milk hormones: leptin, ghrelin and adiponectin. Clin Nutr 2008;27:42–7. Search in Google Scholar

19. Durham HA, Lovelady CA, Brouwer RJ, Krause KM, Ostbye T. Comparison of dietary intake of overweight postpartum mothers practicing breastfeeding or formula feeding. J Am Diet Assoc 2011;111:67–74. Search in Google Scholar

20. Bayol SA, Simbi BH, Bertrand JA, Stickland NC. Offspring from mothers fed a ‘junk food’ diet in pregnancy and lactation exhibit exacerbated adiposity that is more pronounced in females. J Physiol 2008;586:3219–30. Search in Google Scholar

21. Bayol SA, Farrington SJ, Stickland NC. A maternal ‘junk food’ diet in pregnancy and lactation promotes an exacerbated taste for ‘junk food’ and a greater propensity for obesity in rat offspring. Br J Nutr 2007;98:843–51. Search in Google Scholar

22. Simpson J, Smith AD, Fraser A, Sattar N, Lindsay RS, et al. Programming of adiposity in childhood and adolescence: associations with birth weight and cord blood adipokines. J Clin Endocrinol Metab 2016;102:499–506. Search in Google Scholar

23. Steyn NP, Parker WA, Nel JH, Rosemary A, Mbithe D. The nutrition transition and adequacy of the diet of pregnant women in Kenya. International Conference on Nutrition and Food Sciences IACSIT Press, Singapore, vol. 39, 2012. Search in Google Scholar

24. Lim SY, Yoo HJ, Kim AL, Oh JA, Kim HS, et al. Nutritional intake of pregnant women with gestational diabetes or type 2 diabetes mellitus. Clin Nutr Res 2013;2:81–90. Search in Google Scholar

25. Turkey Nutrition and Health Survey (TNHS)-2010. Beslenme Durumu ve Alışkanlıklarının Değerlendirilmesi Sonuç Raporu [Report on the Evaluation of Nutrition Status and Habits]. Sağlık Bakanlığı Yayın No: 931, Ankara, 2014. Search in Google Scholar

26. Madanijah S, Rimbawan R, Briawan D, Zulaikhah Z, Andarwulan N, et al. Nutritional status of lactating women in Bogor district, Indonesia: cross-sectional dietary intake in three economic quintiles and comparison with pre-pregnant women. Br J Nutr 2016;116:S67–74. Search in Google Scholar

27. Garcia C, Duan RD, Brevaut-Malaty V, Gire C, Millet V, et al. Bioactive compounds in human milk and intestinal health and maturity in preterm newborn: an overview. Cell Mol Biol 2013;59:108–31. Search in Google Scholar

28. Ucar B, Kırel B, Bör Ö, Κılıç FS, Doğruel Ν, et al. Breast milk leptin concentrations in initial and terminal milk samples: relationships to maternal and infant plasma leptin concentrations, adiposity, serum glucose, insulin, lipid and lipoprotein levels. J Pediatr Endocrinol Metab 2000;13:149–56. Search in Google Scholar

29. Martin LJ, Woo JG, Geraghty SR, Altaye M, Davidson BS, et al. Adiponectin is present in human milk and is associated with maternal factors. Am J Clin Nutr 2006;83:1106–11. Search in Google Scholar

30. Ng PC, Lee CH, Lam CW, Chan IH, Wong E, et al. Ghrelin in preterm and term newborns: relation to anthropometry, leptin and insulin. Clin Endocrinol 2005;63:217–22. Search in Google Scholar

31. Mehta R, Petrova A. Biologically active breast milk proteins in association with very preterm delivery and stage of lactation. J Perinatol 2011;31:58–62. Search in Google Scholar

32. Novak EM, Innis SM. Impact of maternal dietary n-3 and n-6 fatty acids on milk medium-chain fatty acids and the implications for neonatal liver metabolism. Am J Physiol Endocrinol Metab 2011;301:E807–17. Search in Google Scholar

33. Dorea JG. Selenium and breast-feeding. Br J Nutr 2002;88:443–61. Search in Google Scholar

34. Innis SM. Impact of maternal diet on human milk composition and neurological development of infants. Am J Clin Nutr 2014;99:734S–41S. Search in Google Scholar

35. Lonnerdal B. Effects of maternal dietary intake on human milk composition. J Nutr 1986;116:499–513. Search in Google Scholar

36. Aaltonen J, Ojala T, Laitinen K, Poussa T, Ozanne S, et al. Impact of maternal diet during pregnancy and breastfeeding on infant metabolic programming: a prospective randomized controlled study. Eur J Clin Nutr 2011;65:10–9. Search in Google Scholar

37. Shaikh MG, Anderson JM, Hall SK, Jackson MA. Transient neonatal hypothyroidism due to a maternal vegan diet. J Pediatr Endocrinol Metab 2003;16:111–4. Search in Google Scholar

Received: 2018-05-02
Accepted: 2018-08-02
Published Online: 2018-08-29
Published in Print: 2018-10-25

©2018 Walter de Gruyter GmbH, Berlin/Boston