title: Milk at altitude: Human milk macronutrient composition in a high-altitude adapted population of Tibetans.
abstract: OBJECTIVE
  The physiological challenges of high altitude have led to population-specific patterns of adaptation. These include alterations to child growth and reproduction, including lactation. However, while breastfeeding has been investigated, nothing is known about milk composition in high altitude adapted populations.
  
  
  METHODS
  Here, we investigate milk macronutrient composition, volume, and energy in a sample of 82 Tibetans living at high and low altitude in rural villages (Nubri Valley, Nepal) and at low altitude in Kathmandu, Nepal. Milk samples were collected in the morning using hand expression, frozen, and assayed for fat, protein, and total sugars. Reproductive histories and health recalls were also collected.
  
  
  RESULTS
  Milk fat averaged 5.2 ±2.0 g/100 mL, milk sugar 7.37 ± 0.49 g/100 mL, and milk protein 1.26 ± 0.35 g/100 mL for a mean energy density of 81.4 ± 17.4 kcal/100 mL. There were no associations between altitude of residence and milk composition; however, overall milk fat was high compared to reference populations. Within the three groups, milk fat was positively associated with infant age (B = 0.103; p < 0.001) and maternal triceps skinfold thickness (B = 0.095; p < 0.01) while milk sugar was significantly and inversely associated with maternal parity and triceps skinfold thickness.
  
  
  CONCLUSIONS
  Milk fat, and consequently milk energy, may be increased in high-altitude adapted Tibetans when compared to populations living at low altitude. The association between milk fat and maternal adiposity suggests that milk composition may be sensitive to maternal adiposity in this sample, likely reflecting increased metabolic costs of producing a high-fat milk.
authors.affiliation: Department of Anthropology, Washington University in St. Louis, St. Louis, Missouri, 63130.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Quinn
authors.affiliation: Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
authors.forename: Kesang
authors.initials: K
authors.lastname: Diki Bista
authors.affiliation: Department of Anthropology, Washington University in St. Louis, St. Louis, Missouri, 63130.
authors.forename: Geoff
authors.initials: G
authors.lastname: Childs
mesh_terms: D000222:Adaptation, Physiological / Q000502:physiology; D000328:Adult; D000531:Altitude; D002241:Carbohydrates / Q000032:analysis; D005223:Fats / Q000032:analysis; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008895:Milk, Human / Q000737:chemistry* / Q000502:physiology; D009390:Nepal; D011506:Proteins / Q000032:analysis; D018609:Tibet; D055815:Young Adult
chemical_list: D002241:Carbohydrates; D005223:Fats; D011506:Proteins
keywords: breast milk; high altitude; infants; lactation; milk composition