Perspective: Human Milk Composition and Related Data for National Health and Nutrition Monitoring and Related Research
National health and nutrition monitoring is an important federal effort in both United States and Canada, and the basis for many national and state nutrition and health policies. Our understanding of exposures through human milk (HM) remains out of reach due to lack of representative data on its composition and intake volume. The purpose of this paper is to provide an overview of the current national monitoring activities for HM-fed children, including human milk composition (HMC) data. Furthermore, we provide a framework for collection and reporting of data on HMC for national health and nutrition monitoring. HM contains myriad of components. Several hundreds of potential measures in over 40 categories were elucidated including - macronutrients, micronutrients, bioactives, microbiota, and environmental chemicals. We delineated maternal, infant, and temporal factors, feeding practices, and factors for compositional analyses, such as sample handling, storage, and analytical methods that can potentially impact variability in HMC and intake volume. Furthermore, we articulate a vision for a publicly available Human Milk Composition Data Repository (HMCD-R), which can provide a central platform for researchers and public health officials for compiling, evaluating, and sharing HMC data. The compiled compositional and metadata in HMCD-R will provide pertinent measures of central tendency and variability and allow use of modeling techniques to approximate compositional profiles for sub-groups, providing more accurate exposure assessments for purposes of monitoring and surveillance. HMC and related metadata could facilitate understanding the complexity and variability of HM composition, provide crucial data for assessment of infant and maternal nutritional needs, and inform public health policies, food and nutrition programs, and clinical practice guidelines.