Breastmilk and the Link to Overweight/Obesity and Maternal Diet in the Mother-breastmilk-child Triad (BLOOM-Triad)

Analysis of the Transmission of Overweight/Obesity in the Mother-breastmilk-child Triad in Relation to Maternal Cardiometabolic Status and Diet

The prospective 5-month follow-up study will involve 150 mother-infant dyads grouped based on maternal baseline BMI category (normal weight, overweight, obesity). The investigators plan 3 study visits (1, 3, and 6 months postpartum) with analysis the following parameters and outcomes:

1. maternal anthropometry and body composition;
2. maternal dietary intake and dietary patterns (with results of biomarker-based validation);
3. maternal status of lipophilic antioxidants, selected vitamins, and fatty acids profile that may be related to adipose tissue metabolism, inflammation, and cardiometabolic status;
4. maternal metabolomics, adipokines, insulin, selected biomarkers of inflammation, altered glucose metabolism, and oxidation;
5. breastmilk composition assessed by systemic approach (macronutrients, fatty acids profile, lipophilic antioxidants, adipokines, hormones, immunological profile, and preliminary lipidomic analysis in part of the study group);
6. infant growth trajectory, body composition, urine metabolomics, and biomarkers of oxidative stress.

Additionally, maternal and infant stool, buccal swabs, and human milk samples will be banked for further microbiome analysis studies.

Study Overview

• Status: Not yet recruiting
• Conditions: Body Weight; Body Composition; Growth & Development; Adipokines; Carotenoid Status; Obesity & Overweight; Metabolomic Profile; Vitamin E; Inflammation Biomarkers; Human Milk/Breastfeeding; Immunologic Markers; Fatty Acid Status; Infant Body Composition and Metabolism; Maternal Cardiometabolic Health

Detailed Description

The global obesity pandemic continues to escalate, with projections showing 1 in 5 women and 1 in 7 men obese by 2030. Maternal obesity raises the risk of childhood obesity by 264%, and overweight/obese children are more prone to become obese adults.

Obesity-associated metabolic dysfunctions (inflammation, insulin resistance, dyslipidemia) heighten morbidity and mortality risks. Breastfeeding mitigates overweight/obesity risks, yet mothers with overweight/obesity often encounter challenges in initiation, continuation, and altered milk composition, showing elevated levels of leptin, insulin, and n-6/n-3 fatty acids. However, findings on other components, like total fat, fatty acids, insulin, adipokines, carotenoids, and immune factors, remain inconsistent due to methodological limitations and lack of comprehensive analysis. Nonetheless, the potential pro-inflammatory and obesogenic properties of milk produced by mothers with overweight/obesity have been discussed. Recent systematic reviews link breastmilk protein, fat, leptin, and IL-6 to infant growth and adiposity. Findings for other components remain unclear due to small samples, methodological limitations, and lack of a systemic approach to analyze breastmilk as a complex biological system. Alterations in breastmilk composition may stem from disrupted de novo synthesis, transport across the blood-breastmilk barrier, or altered circulating levels. Recent studies showed impaired de novo synthesis of C15:0 and C16:1 fatty acids, probably caused by insulin resistance and reduced long-chain fatty acid transfer linked to inflammation (suppress lipoprotein lipase activity essential for transporting lipid compounds). Hence, poor cardiometabolic status may mediate altered breastfeeding outcomes and milk composition, but it requires further studies. Studies among non-lactating individuals suggested lifestyle and diet play crucial roles in mitigating overweight/obesity metabolic implications (e.g., metabolically healthy obese (MHO) and metabolically obese with normal weight (MONW) phenotypes). Maternal diet can influence breastmilk concentration of certain diet-dependent nutrients and bioactives (e.g., fatty acids, vitamins A, D, and carotenoids). Similarly, prohealthy/unhealthy dietary patterns seem to have beneficial/unfavorable effects on breastmilk composition and breastfeeding outcomes, but results remain inconclusive. Nonetheless, some suggest that diet may mitigate the effects of maternal overweight/obesity on breastmilk composition in mothers with overweight/obesity. The mechanisms linking obesity-related changes in breastmilk to infant development remain unclear. This study addresses this gap by studying the mother-breastmilk-infant triad, focusing on maternal cardiometabolic status, diet, breastmilk composition as a complex biological system, and anthropometric and metabolic outcomes.

This study aims to elucidate the intricate interplay between maternal adiposity, cardiometabolic status, diet, and breastmilk composition and to understand the role of breastmilk in the transmission of obesity and the shaping of infant metabolic health.

Our research questions will aim to determine/explore the following questions:

Q1. How does the maternal BMI category differentiate breastmilk composition from a systemic perspective? Q2. How does maternal cardiometabolic status mediate OW/OB-related alterations in breastmilk composition? Q3. Whether (and how) maternal diet moderates OW/OB-related alterations in breastmilk composition? Q4. Whether (and how) maternal OW/OB differentiates infant metabolomic profile? Q5. Whether (and how) OW/OB-related alterations in breastmilk composition influence infant outcomes and obesity risk? Q6. Whether (and how) maternal dietary patterns moderate adverse health outcomes of maternal OW/OB in infants?

The research hypotheses assume that:

H1. Maternal OW and OB are associated with pro-inflammatory properties and altered breastmilk metabolome via obesity-related low-grade inflammation, metabolic alterations, and oxidative stress, not dietary differences.

H2. Metabolically healthy OW and OB mothers produce less altered breastmilk than metabolically unhealthy mothers, as cardiometabolic status mediates between adiposity and breastmilk composition.

H3. A pro-healthy dietary pattern attenuates, and a westernized dietary pattern exacerbates obesity-related alterations in breastmilk composition due to differences in concentrations of pro-, anti-inflammatory, and antioxidant dietary compounds.

H4. Infants of OW and OB mothers have altered growth trajectories and metabolic pathways, higher fat mass, and oxidative stress compared to infants of NW mothers.

H5. Obesity-related changes in breastmilk composition determine alterations in infant outcomes.

H6. Maternal pro-health/westernized dietary patterns and metabolic health mitigate/exacerbate the adverse effects of overweight and obesity on infant outcomes.

The investigators will verify these hypotheses based on results collected using gold standards and novel body composition assessment and analytical methods (DXA scans, HPLC, GC-MS, ELISA, and LC-MS), nutrient-based and dietary pattern-based dietary assessment with biomarkers validation, in-depth evaluation of maternal cardiometabolic status and infant outcomes, and a systemic approach to breastmilk composition analysis. The findings will lay the foundation for tailored, evidence-based interventions to disrupt the intergenerational transmission of obesity. Furthermore. contribute to advancing the health sciences discipline and decreasing the global health burden of overweight and obesity, supporting the realization of WHO's Global Nutrition Goals.

• Study Type: Observational
• Enrollment (Estimated): 165

Contacts and Locations

• Study Contact: Name: Monika A. Zielinska-Pukos, PhD; Phone Number: +48225937125; Email: monika_zielinska_pukos@sggw.edu.pl
• Study Contact Backup: Name: Jadwiga Hamulka, Professor; Phone Number: +48225937122; Email: jadwiga_hamulka@sggw.edu.pl

Study Locations

• Canada
  • British Columbia
    • Vancouver, British Columbia, Canada, V6T 1Z4
      • Food, Nutrition and Health, Uviversity of British Columbia; Affiliated Investigator, Healthy Starts, BC Children's Hospital Research Institute & Women's Health Research Institute
• Poland
  • Lower Silesian Voivodeship
    • Wroclaw, Lower Silesian Voivodeship, Poland, 50-367
      • Wroclaw Medical University
  • Masovian Voivodeship
    • Warsaw, Masovian Voivodeship, Poland, 00-791
      • National Institute of Public Health NIH - National Research Institute
    • Warsaw, Masovian Voivodeship, Poland, 02-776
      • Department of Human Nutrition, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (SGGW-WULS)
      • Principal Investigator: Monika A. Zielinska-Pukos, PhD
      • Sub-Investigator: Jadwiga Hamulka, Professor
      • Sub-Investigator: Malgorzata E. Drywien, PhD
      • Sub-Investigator: Magdalena Gornicka, PhD
      • Sub-Investigator: Marta Jeruszka-Bielak, PhD
      • Sub-Investigator: Joanna Frackiewicz, PhD
      • Sub-Investigator: Kacper Szewczyk, PhD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

• Sampling Method: Non-Probability Sample

Study Population

A group of 165 mother-infant dyads is planned to be recruited from a community sample. The study group will be recruited via advertisements on the Internet, social media, health facilities, and information distributed to midwives and lactation consultants. To reduce bias related to the lack of random selection and increase the quality of our results, the investigators will match participants by maternal age, infant sex, and sociodemographic status - factors potentially affecting exposures and outcomes measured in our study.

Description

Inclusion Criteria:

for mother:

• at least 19 years,
• plan of exclusively or predominantly breastfeeding for 6 months,
• consent to a sampling of biological material and participate in all planned procedures (for both mother and infant),
• willingness to finish the follow-up,
• well-understanding of the Polish language (for non-Polish nationalities); for infants:
• 1 month or less,
• clinically healthy,
• none or one formula feeding per day

Exclusion Criteria:

for mother:

• type 1 or 2 diabetes diagnosed before pregnancy,
• uncontrolled thyroid disease,
• breastfeeding more than 1 child or being a milk donor,
• tobacco/alcohol use during pregnancy or currently,
• inability to express a sufficient amount of milk; for infants:
• congenital disease,
• birth from a multiple pregnancy,
• preterm birth (<37 Hbd).

Study Plan

How is the study designed?

Number of groups / cohorts

3

Cohorts and Interventions

Group / Cohort
Normal weight (NW); n=55 (maternal BMI at baseline 18.5-24.9 kg/m²)
Overweight (OW); n=55 (maternal BMI at baseline 25-29.9 kg/m²)
Obesity (OB); n=55 (maternal BMI at baseline >29.9 kg/m²)

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Difference between groups and change from 1 to 6 months postpartum in maternal body fat percentage	Assessment of changes in total body fat content, assessed by a bioelectrical impedance analysis (BIA) and a dual-energy X-ray absorptiometer (DXA). Results will be reported as a percentage (%).	1, 3, and 6 months postpartum
Difference between groups and change from 1 to 6 months postpartum in maternal fat-free mass percentage	Assessment of changes in fat-free mass, assessed by a bioelectrical impedance analysis (BIA) and a dual-energy X-ray absorptiometer (DXA). Results will be reported as a percentage (%).	1, 3, and 6 months postpartum
Difference between groups and change from 1 to 6 months postpartum in maternal Visceral Fat Area	Assessment of changes in visceral fat area, assessed by DXA. Results will be reported as square centimeters (cm^2).	1, 3, and 6 months postpartum
Difference between groups and change from 1 to 6 months postpartum in maternal Subcutaneous Fat Area	Assessment of changes in subcutaneous fat area, assessed by DXA. Results will be reported as square centimeters (cm^2).	1, 3, and 6 months postpartum
Difference between groups and change from 1 to 6 months postpartum in maternal Body Mass Index (BMI)	Weight and height will be combined to report BMI in kg/m^2.	1, 3, and 6 months postpartum
Difference between groups and change from 1 to 6 months postpartum in maternal Waist-Hip Ratio (WHR)	Assessment of fat distribution calculated as the waist measurement divided by the hip measurement (dimensionless ratio).	1, 3, and 6 months postpartum
Difference between groups and change from 1 to 6 months postpartum in maternal Waist-to-Height Ratio (WHtR)	Assessment of fat distribution calculated as the waist measurement divided by height (dimensionless ratio).	1, 3, and 6 months postpartum
Difference between groups and change from 1 to 6 months postpartum in metabolic syndrome (MetS) incidence	Assessment of MetS incidences diagnosed based on the occurence of three from five metabolic abnormalities diagnosed based on International Diabetes Federation-established cut-off points for women for waist circumference (≥80 cm), fasting blood glucose (≥100 mg/dL), triglicerides (≥150 mg/dL), HDL cholesterol (<50 mg/dL), blood pressure (systolic SBP ≥ 130 or diastolic ≥ 85 mmHg) as a marker of cardiometabolic health.	1, 3, 6 months postpartum
Difference between groups and change from 1 to 6 months postpartum in maternal glycated haemoglobin (HbA1c)	Assessment of changes in HbA1c (reported in %) as a marker of maternal cardiometabolic health.	1, 3, 6 months postpartum
Difference between groups and change from 1 to 6 months postpartum in Homeostatic Model Assessment - Insulin Resistance (HOMA-IR)	Assessment of HOMA-IR calculated as the product of fasting insulin [µIU/mL] and fasting glucose [µIU/mL] divided by 22.5 (dimensionless ratio) as an indicator of maternal cardiometabolic health.	1, 3, 6 months postpartum
Difference between groups and change from 1 to 6 months postpartum in maternal serum leptin	Assessment of maternal serum leptin assessed by the ELISA method as an indicator of maternal cardiometabolic health.	1, 3, 6 months postpartum
Difference between groups and change from 1 to 6 months postpartum in maternal serum adiponectin	Assessment of maternal serum adiponectin assessed by the ELISA method as an indicator of maternal cardiometabolic health.	1, 3, 6 months postpartum
Difference between groups and change from 1 to 6 months postpartum in maternal serum and infant urine Retinol-Binding Protein-4 (RBP4)	Assessment of maternal serum and infant urine RBP-4 assessed by the ELISA method as an indicator of maternal and infant cardiometabolic health.	1, 3, 6 months postpartum
Difference between groups and change from 1 to 6 months postpartum in human milk macronutrients	Assessment of human milk macronutrients (fat, carbohydrate, dry material, protein, true protein) concentration assessed by mid-infrared (mid-IR) transmission spectroscopy method. Results will be reported in grams per 100 mL.	1, 3, 6 months of postpartum
Difference between groups and change from 1 to 6 months postpartum in human milk energy value	Assessment of human milk energy value assessed by mid-infrared (mid-IR) transmission spectroscopy method. Results will be reported in kcal per 100 mL.	1, 3, 6 months of postpartum
Difference between groups and change from 1 to 6 months postpartum in human milk secretory immunoglobulin A (S-IgA)	Assessment of human milk S-IgA assessed by Enzyme-Linked Immunosorbent Assay (ELISA) method. Results will be reported in grams per liter [g/L].	1, 3, and 6 months postpartum
Difference between groups and change from 1 to 6 months postpartum in human milk lactoferrin	Assessment of human milk lactoferrin assessed by ELISA method. Results will be reported in grams per liter [g/L].	1, 3, and 6 months postpartum
Difference between groups and change from 1 to 6 months postpartum in human milk leptin	Assessment of human milk leptin assessed by ELISA method.	1, 3, 6 months of postpartum
Difference between groups and change from 1 to 6 months postpartum in human milk adiponectin	Assessment of human milk adiponectin assessed by ELISA method.	1, 3, 6 months of postpartum
Difference between groups and change from 1 to 6 months postpartum in human milk insulin	Assessment of human milk insulin assessed by ELISA method.	1, 3, 6 months of postpartum
Difference between groups and change from 1 to 6 months postpartum in human milk High-Sensitivity C-Reactive Protein (hs-CRP)	Assessment of human milk hsCRP assessed by ELISA method.	1, 3, 6 months of postpartum
Difference between groups and change from 1 to 6 months postpartum in human milk interleukin 1 (IL-1)	Assessment of human milk IL-1 assessed by ELISA method.	1, 3, 6 months of postpartum
Difference between groups and change from 1 to 6 months postpartum in human milk interleukin 6 (IL-6)	Assessment of human milk IL-6 assessed by ELISA method.	1, 3, 6 months of postpartum
Difference between groups and change from 1 to 6 months postpartum in human milk Tumor Necrosis Factor-alpha (TNF-alfa)	Assessment of human milk TNF-alfa assessed by ELISA method.	1, 3, 6 months of postpartum
Difference between groups and change from 1 to 6 months postpartum in human milk fatty acid profile	Assessment of human milk fatty acid profile analyzed as methyl ester (FAME) by gas chromatography. Results will be reported as concentration within a total fat [% wt/wt].	1, 3, 6 months of postpartum
Difference between groups and the change from 1 to 6 months of life in infant anthropometric development	Assessment of anthropometric development calculated as weight-, length-, BMI-, and head circumference z-scores for age and sex, analyzed based on WHO standards.	1, 3, 6 months of life
Difference between groups and the change from 1 to 6 months of life in infant body fat-free mass percentage	Assessment of changes in total body fat-free mass content, assessed by the whole-body DXA scans with a vacuum cushion to prevent movement. Results will be reported as a percentage (%).	1, 6 months of life
Difference between groups and the change from 1 to 6 months of life in infant body fat percentage	Assessment of changes in total body fat content, assessed by the whole-body DXA scans with a vacuum cushion to prevent movement. Results will be reported as a percentage (%).	1, 6 months of life

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Difference between groups and the change from 1 to 6 months postpartum in the maternal resting metabolic rate (RMR)	Assessment of the rate of maternal energy metabolism assessed by indirect calorimetry. Results will be reported as kilocalories per day [kcal/d].	1, 3, 6 months postpartum
Difference between groups and the change from 1 to 6 months postpartum in maternal dietary intake	Assessment of maternal dietary intake using 3-day food records.	1, 3, 6 months postpartum
Difference between groups and the change from 1 to 6 months postpartum in maternal dietary habits	Assessment of maternal dietary intake using a food frequency questionnaire (FFQ).	1, 3, 6 months postpartum
Difference between groups and change from 1 to 6 months postpartum in maternal short- and long-term fatty acid status	Assessment of serum blood and erythrocyte membranes fatty acids profile analyzed by gas chromatography. Results will be reported as concentration within a total fat [% wt/wt].	1, 3, 6 months postpartum
Difference between groups and change from 1 to 6 months postpartum in maternal and human milk lipophilic antioxidants and vitamins	Assessment of plasma and human milk carotenoids, retinol, and vitamin E, as well as serum vitamin D (25(OH)D) analyzed by high-performance liquid chromatography (HPLC). Results will be reported as micromoles per liter [µmol/L].	1, 3, 6 months postpartum
Difference between groups and the change from 1 to 6 months of life in infant skin carotenoid status	Assessment of skin carotenoids assessed by reflectance spectroscopy with Veggie Meter (Longevity Link, Ltd.). Results will be reported as a skin carotenoid score (SCS; 0-800, higher values mean more carotenoids)	1, 3, 6 months of life
Difference between groups and change from 1 to 6 months postpartum in maternal and infant urine 8-isoprostane	Assessment of maternal and infant urine 8-isoprostane analyzed by the ELISA as an indicator of oxidative stress. Results will be reported as picograms per milligram of creatinine [pg per mg of creatinine].	1, 3, 6 months postpartum
Difference between groups and change from 1 to 6 months postpartum in maternal serum hsCRP	Assessment of maternal serum hsCRP assessed by the ELISA method as an indicator of systemic inflammation.	1, 3, 6 months postpartum
Difference between groups and change from 1 to 6 months postpartum in maternal serum IL-1	Assessment of maternal serum IL-1 assessed by the ELISA method as an indicator of systemic inflammation.	1, 3, 6 months postpartum
Difference between groups and change from 1 to 6 months postpartum in maternal serum IL-6	Assessment of maternal serum IL-6 assessed by the ELISA method as an indicator of systemic inflammation.	1, 3, 6 months postpartum
Difference between groups and change from 1 to 6 months postpartum in maternal serum TNF-alfa	Assessment of maternal serum TNF-alfa assessed by the ELISA method as an indicator of systemic inflammation.	1, 3, 6 months postpartum
Difference between groups and change from 1 to 3 months postpartum in human milk lipidomics	Assessment of human milk triacylglycerols (TG), diacylglycerols (DG), phosphatidylcholine (PC), sphingomyelin (SM), and phosphatidylethanolamine (PE) assessed by targeted lipidomic analysis using the LC-MS. Results expressed as the percentage relative amount of many lipid species.	1, 3 months postpartum
Difference between groups and change from 1 to 6 months postpartum in metabolomic profile of maternal serum blood and infant urine	Assessment of the serum and urine non-targeted metabolomic profiles.	1, 3, 6 months postpartum

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Difference between groups and change from 1 to 6 months postpartum in Bone Mineral Density (BMD)	Assessment of changes in bone mineral density (BMD) using DXA.	1, 3, 6 months postpartum
Difference between groups and change from 1 to 6 months postpartum in maternal hydration status	Assessment of changes in hydration status, assessed by urine osmolality [mOsm/kg].	1, 3, 6 months postpartum
Difference between groups and change from 1 to 6 months postpartum in maternal well-being	Assessment of maternal well-being assessed using the WHO-5 Well-being Index. Results will be expressed as a percentage score from 0 to 100, with a higher score indicating a better quality of life.	1, 3, 6 months postpartum
Difference between groups and change from 1 to 6 months postpartum in maternal fatigue	Assessment of maternal fatigue using the Fatigue Assessment Scale (FAS). Results will be expressed as a FAS score ranging from 10 to 50, with higher scores indicating more severe fatigue.	1, 3, 6 months postpartum
Difference between groups and change from 1 to 6 months postpartum in maternal perceived stress	Assessment of maternal perceived stress assessed by the Perceived Stress Scale (PSS-10). Results will be expressed as a PSS-10 score ranging from 0 to 40, with higher scores indicating greater perceived stress.	1, 3, 6 months postpartum
Difference between groups and change from 1 to 6 months postpartum in maternal postpartum depression	Assessment of maternal postpartum depression risk assessed by the Edinburgh Postnatal Depression Scale (EPDS). Results will be expressed as an EPDS score ranging from 0 to 30, with higher scores indicating greater risk of postpartum depression, and values >=13 indicate probable depression.	1, 3, 6 months postpartum
Difference between groups and change from 1 to 6 months postpartum in maternal breastfeeding self-efficacy	Assessment of maternal breastfeeding self-efficacy assessed by the Breastfeeding Self-Efficacy Scale (BSES-SF). Results will be reported as a BSES-SF score ranging from 14 to 70, with higher scores indicating greater confidence in breastfeeding.	1, 3, 6 months postpartum

Collaborators and Investigators

• Sponsor: Warsaw University of Life Sciences
• Collaborators: Wroclaw Medical University; National Science Centre, Poland; National Institute of Public Health, National Research Institute, Poland

Publications and helpful links

General Publications

• Isganaitis E, Venditti S, Matthews TJ, Lerin C, Demerath EW, Fields DA. Maternal obesity and the human milk metabolome: associations with infant body composition and postnatal weight gain. Am J Clin Nutr. 2019 Jul 1;110(1):111-120. doi: 10.1093/ajcn/nqy334.
• Heslehurst N, Vieira R, Akhter Z, Bailey H, Slack E, Ngongalah L, Pemu A, Rankin J. The association between maternal body mass index and child obesity: A systematic review and meta-analysis. PLoS Med. 2019 Jun 11;16(6):e1002817. doi: 10.1371/journal.pmed.1002817. eCollection 2019 Jun.
• Panagos PG, Vishwanathan R, Penfield-Cyr A, Matthan NR, Shivappa N, Wirth MD, Hebert JR, Sen S. Breastmilk from obese mothers has pro-inflammatory properties and decreased neuroprotective factors. J Perinatol. 2016 Apr;36(4):284-90. doi: 10.1038/jp.2015.199. Epub 2016 Jan 7.
• Falize C, Savage M, Jeanes YM, Dyall SC. Evaluating the relationship between the nutrient intake of lactating women and their breast milk nutritional profile: a systematic review and narrative synthesis. Br J Nutr. 2024 Apr 14;131(7):1196-1224. doi: 10.1017/S0007114523002775. Epub 2023 Dec 6.
• WHO/UNICEF. (2019). Recommendations for data collection, analysis and reporting on anthropometric indicators in children under 5 years old (W. H. O. and the U. N. C. F. (UNICEF) (ed.)).
• CDC. National Health and Nutrition Examination Survey (NHANES): Anthropometry Procedures Manual. 2020. https://wwwn.cdc.gov/nchs/data/nhanes/public/2019/manuals/2020-Anthropometry-Procedures-Manual-508.pdf
• Zielinska-Pukos, M. A., Wesołowska, A., & Hamułka, J. (2024d). Longitudinal and circadian variation in breastmilk macronutrient composition across the first six months of lactation - associations with maternal determinants and infant anthropometric development. Acta Sci. Pol. Technol. Aliment, 23(1), 65-76.
• Zielinska-Pukos MA, Michalska-Kacymirow M, Kurek E, Bulska E, Grabowicz-Chadrzynska I, Wesolowska A, Hamulka J. Breastmilk mineral composition among well-educated mothers from Central Poland - Associations with maternal dietary intake, dietary patterns and infant psychomotor development. J Trace Elem Med Biol. 2024 May;83:127393. doi: 10.1016/j.jtemb.2024.127393. Epub 2024 Jan 13.
• Zielinska-Pukos MA, Kopiasz L, Hamulka J. The Effect of Maternal Overweight/Obesity on Serum and Breastmilk Leptin, and Its Associations with Body Composition, Cardiometabolic Health Indices, and Maternal Diet: The BLOOM Study. Metabolites. 2024 Apr 13;14(4):221. doi: 10.3390/metabo14040221.
• Zielinska-Pukos MA, Kopiasz L, Hamulka J. No effect of circulating leptin on energy metabolism in normal weight or overweight/obese lactating mothers: The case-control Breastmilk and the Link to Overweight/Obesity and Maternal diet (BLOOM) study. Clin Nutr ESPEN. 2024 Oct;63:878-886. doi: 10.1016/j.clnesp.2024.08.025. Epub 2024 Aug 30.
• Zielinska-Pukos MA, Brys J, Wesolowska A, Hamulka J. Breastmilk PUFA strongly associated with maternal dietary intake but not anthropometric parameters and breastmilk carotenoids. Prostaglandins Leukot Essent Fatty Acids. 2022 Nov;186:102505. doi: 10.1016/j.plefa.2022.102505. Epub 2022 Oct 9.
• Zielinska-Pukos MA, Brys J, Kucharz N, Chrobak A, Wesolowska A, Grabowicz-Chadrzynska I, Hamulka J. Factors Influencing Cortisol Concentrations in Breastmilk and Its Associations with Breastmilk Composition and Infant Development in the First Six Months of Lactation. Int J Environ Res Public Health. 2022 Nov 10;19(22):14809. doi: 10.3390/ijerph192214809.
• Zielinska MA, Hamulka J, Wesolowska A. Carotenoid Content in Breastmilk in the 3rd and 6th Month of Lactation and Its Associations with Maternal Dietary Intake and Anthropometric Characteristics. Nutrients. 2019 Jan 18;11(1):193. doi: 10.3390/nu11010193.
• Zielinska MA, Wesolowska A, Pawlus B, Hamulka J. Health Effects of Carotenoids during Pregnancy and Lactation. Nutrients. 2017 Aug 4;9(8):838. doi: 10.3390/nu9080838.
• Zhou XD, Chen QF, Yang W, Zuluaga M, Targher G, Byrne CD, Valenti L, Luo F, Katsouras CS, Thaher O, Misra A, Ataya K, Oviedo RJ, Pik-Shan Kong A, Alswat K, Lonardo A, Wong YJ, Abu-Abeid A, Al Momani H, Ali A, Molina GA, Szepietowski O, Jumaev NA, Kizilkaya MC, Viveiros O, Toro-Huamanchumo CJ, Yen Kok KY, Ospanov O, Abbas SI, Robertson AG, Fouad Y, Mantzoros CS, Zhang H, Mendez-Sanchez N, Sookoian S, Chan WK, Treeprasertsuk S, Adams L, Ocama P, Ryan JD, Perera N, Sharara AI, Al-Busafi SA, Opio CK, Garcia M, Lim-Loo MC, Ruiz-Ucar E, Prasad A, Casajoana A, Abdelbaki TN, Zheng MH. Burden of disease attributable to high body mass index: an analysis of data from the Global Burden of Disease Study 2021. EClinicalMedicine. 2024 Sep 24;76:102848. doi: 10.1016/j.eclinm.2024.102848. eCollection 2024 Oct.
• Zaidi Y, Stroh R, Moran NE. Systematic review of carotenoid concentrations in human milk and infant blood. Nutr Rev. 2022 Aug 8;80(9):2029-2050. doi: 10.1093/nutrit/nuac018.
• Yin WJ, Wang P, Ma SS, Tao RX, Hu HL, Jiang XM, Zhang Y, Tao FB, Zhu P. Vitamin D supplementation for cardiometabolic risk markers in pregnant women based on the gestational diabetes mellitus or obesity status : a randomized clinical trial. Eur J Nutr. 2024 Oct;63(7):2599-2609. doi: 10.1007/s00394-024-03443-6. Epub 2024 Jun 15.
• Yan S, Chen S, Liu Y, Liang H, Zhang X, Zhang Q, Xiu J. Associations of serum carotenoids with visceral adiposity index and lipid accumulation product: a cross-sectional study based on NHANES 2001-2006. Lipids Health Dis. 2023 Nov 30;22(1):209. doi: 10.1186/s12944-023-01945-6.
• World Obesity Federation. (2022). World Obesity Atlas 2022. World Obesity Federation.
• World Health Organization. (2022). WHO European Regional Obesity Report 2022. WHO Regional Office for Europe
• Walker RE, Harvatine KJ, Ross AC, Wagner EA, Riddle SW, Gernand AD, Nommsen-Rivers LA. Fatty Acid Transfer from Blood to Milk Is Disrupted in Mothers with Low Milk Production, Obesity, and Inflammation. J Nutr. 2023 Jan 14;152(12):2716-2726. doi: 10.1093/jn/nxac220.
• Sivalogan K, Liang D, Accardi C, Diaz-Artiga A, Hu X, Mollinedo E, Ramakrishnan U, Teeny SN, Tran V, Clasen TF, Thompson LM, Sinharoy SS. Human Milk Composition Is Associated with Maternal Body Mass Index in a Cross-Sectional, Untargeted Metabolomics Analysis of Human Milk from Guatemalan Mothers. Curr Dev Nutr. 2024 Apr 10;8(5):102144. doi: 10.1016/j.cdnut.2024.102144. eCollection 2024 May.
• Scime NV, Turner S, Miliku K, Simons E, Moraes TJ, Field CJ, Turvey SE, Subbarao P, Mandhane PJ, Azad MB. Association of Human Milk Fatty Acid Composition with Maternal Cardiometabolic Diseases: An Exploratory Prospective Cohort Study. Breastfeed Med. 2024 May;19(5):357-367. doi: 10.1089/bfm.2024.0019. Epub 2024 Mar 19.
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• Asadi Z,Bahrami A,Zarban A,Asadian AH,Ferns GA,Karbasi S

Study record dates

Study Major Dates

• Study Start (Estimated): February 1, 2026
• Primary Completion (Estimated): February 1, 2029
• Study Completion (Estimated): September 1, 2029

Study Registration Dates

• First Submitted: January 19, 2026
• First Submitted That Met QC Criteria: March 2, 2026
• First Posted (Actual): March 9, 2026

Study Record Updates

• Last Update Posted (Actual): March 9, 2026
• Last Update Submitted That Met QC Criteria: March 2, 2026
• Last Verified: January 1, 2026

More Information

Terms related to this study

• Keywords: Oxidative stress; Inflammation; Obesity; Overweight; Metabolomics; Body composition; Diet; Adipokines; Lactation; Carotenoids; Fatty acids; Infant development; Tocopherols
• Additional Relevant MeSH Terms: Pathologic Processes; Nutrition Disorders; Overnutrition; Pathological Conditions, Signs and Symptoms; Behavior; Nutritional and Metabolic Diseases; Signs and Symptoms; Feeding Behavior; Overweight; Obesity; Body Weight; Inflammation; Breast Feeding
• Other Study ID Numbers: 2024/55/B/NZ9/01126

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No