(P06-011-25) Nutrient Composition of Defatted Human Milk for Chylothorax and Very Long-Chain Acyl-CoA Dehydrogenase Deficiency

Objectives: Human milk feeding is the gold standard for infant nutrition but is usually discontinued for six weeks in chylothorax and permanently in severe forms of very long-chain acyl-CoA dehydrogenase (VLCAD) deficiency. Defatted human milk feeding is an alternative to complete human milk restriction but may be inadequate for infant growth and development. The purpose of this study was to evaluate the full nutrient content of defatted human milk.

Methods: Human milk was obtained from Mommy’s Milk Human Milk Research Biorepository (San Diego, CA). Samples from morning (n=10), afternoon (n=10), and evening (n=10) expressions were thawed and pooled. Four methods of fat removal were performed: 1) centrifugation (835 x g, 15 min, 2 °C), 2) centrifugation (835 x g, 15 min, room temperature), 3) electric cream separator (Janschitz, FJ130 ERR; room temperature), and 4) gravity separation; removing the fat layer after storing (2 °C, 24 hr) and again after another 48 hr. Full nutrient analysis was conducted at Eurofins Nutrition Analysis Center (Tustin, CA). Descriptive statistics were computed, and individual nutrient levels were compared between defatted and reference milk groups.

Results: Total triglycerides decreased the most by refrigerated centrifugation (87.0 + 0.03%) and least by cream separator (66.3 + 0.01%). All defatting methods decreased vitamin A and vitamin E by at least 82% and 80%, respectively. Folate decreased the most by nonrefrigerated centrifugation (52.3, SD < 0.01%) and least by cream separator (22.8, SD < 0.01%). Zinc decreased the most by both nonrefrigerated centrifugation (43.5 + 0.06%) and cream separator (43.5 + 0.12%), and least by refrigerated centrifugation (17.7 + 0.10%). Iodine decreased the most by refrigerated centrifugation (40.0, SD < 0.01%) and least by cream separator (31.2, SD < 0.01%).

Conclusions: All defatting methods decreased amounts of vitamin A and vitamin E, and refrigerated centrifuge was most effective in removing total triglyceride. Folate, zinc, and iodine were decreased after defatting. Results of this study can inform fortification and supplementation guidelines of key micronutrients for patients with chylothorax and VLCAD deficiency consuming defatted human milk.

Funding Sources: CHOC CSO Small Grant Program