title: Impact of maternal nutrition on breast-milk composition: a systematic review.
abstract: BACKGROUND
  It is widely reported that maternal diet influences the nutritional composition of breast milk. The amount of variability in human milk attributable to diet remains mostly unknown. Most original studies that reported a dietary influence on breast-milk composition did not assess diet directly, did not quantify its association with milk composition, or both.
  
  
  OBJECTIVE
  To gather the quantitative evidence on this issue, we carried out a systematic PubMed and Medline search of articles published up to January 2015 and filtered the retrieved articles according to predefined criteria.
  
  
  METHODS
  Only studies that provided quantitative information on both maternal diet and milk data, measured in individual healthy mothers of healthy term infants and based on an original observational or experimental design, were included. Exclusion criteria were a focus on supplements, transfer of toxic metals or other contaminants from diet to milk, or on marginally nourished women.
  
  
  RESULTS
  Thirty-six publications-including data on 1977 lactating women-that matched our criteria were identified. Seventeen studies investigated dietary effects on fatty acids in breast milk. The rest included studies that focused on a diverse spectrum of other nutritional properties of breast milk. The largest evidence, in terms of number of articles, for any link between maternal diet and a nutritive property of breast milk came from 3 studies that supported the link between fish consumption and high docosahexaenoic acid in breast milk and 2 studies that reported a positive correlation between dietary vitamin C and milk concentrations of this vitamin.
  
  
  CONCLUSIONS
  The available information on this topic is scarce and diversified. Most of the evidence currently used in clinical practice to make recommendations is limited to studies that only reported indirect associations.
authors.affiliation: Laboratory of Medical Statistics, Biometry and Epidemiology "G.A. Maccacaro," and francesca.bravi@unimi.it.
authors.forename: Francesca
authors.identifier: http://orcid.org/0000-0003-0173-5319
authors.initials: F
authors.lastname: Bravi
authors.affiliation: Nutricia Research, Utrecht, Netherlands;
authors.forename: Frank
authors.initials: F
authors.lastname: Wiens
authors.affiliation: Laboratory of Medical Statistics, Biometry and Epidemiology "G.A. Maccacaro," and Unit of Medical Statistics, Biometry and Bioinformatics, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; and.
authors.forename: Adriano
authors.identifier: http://orcid.org/0000-0003-1451-8292
authors.initials: A
authors.lastname: Decarli
authors.affiliation: Laboratory of Medical Statistics, Biometry and Epidemiology "G.A. Maccacaro," and.
authors.forename: Alessia
authors.initials: A
authors.lastname: Dal Pont
authors.affiliation: Pediatric Clinic, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy; Fondazione IRCCS Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Carlo
authors.identifier: http://orcid.org/0000-0002-5006-0832
authors.initials: C
authors.lastname: Agostoni
authors.affiliation: Laboratory of Medical Statistics, Biometry and Epidemiology "G.A. Maccacaro," and.
authors.forename: Monica
authors.identifier: http://orcid.org/0000-0002-4542-4996
authors.initials: M
authors.lastname: Ferraroni
mesh_terms: D000328:Adult; D002657:Child Development; D018849:Controlled Clinical Trials as Topic; D004032:Diet / Q000009:adverse effects; D000072001:Diet, Healthy; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D007774:Lactation / Q000378:metabolism*; D008297:Male; D008895:Milk, Human / Q000737:chemistry*; D009753:Nutritive Value; D064887:Observational Studies as Topic; D010349:Patient Compliance; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D039401:Prenatal Nutritional Physiological Phenomena; D064167:Recommended Dietary Allowances
keywords: breastfeeding; fatty acids; human milk; maternal diet; nutrients