Development of a biochemical marker to detect current breast milk intake

Ruth Addison, Lauren Hill, Lars Bode, Bianca Robertson, Biswa Choudhury, David Young, Charlotte Wright, Clare Relton, Ada L Garcia, David M Tappin

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)
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The WHO recommends exclusive breastfeeding for 6 months, but despite interventions, breastfeeding rates remain stubbornly low. Financial voucher incentives have shown promise but require a biomarker for validation of intake. This study aimed to develop a simple biochemical assay of infant urine that would tell if an infant was receiving any breast milk to validate maternal report. Urine samples were collected and snap frozen from 34 infants attending with minor illness or feeding problems, of whom 12 infants were exclusively breast fed, 9 exclusively formula fed and 11 mixed breast/formula fed.. High performance anion exchange chromatography was used to identify discriminating patterns of monosaccharide composition of unconjugated glycans in a sequence of three experiments. The absolute concentration of all human milk oligosaccharides measured blind could detect 'any breastfeeding' only with a sensitivity of 48% and specificity of 78%. Unblinded examination of N-acetylglucosamine (GlcNAc) measured as GlcNH2 after hydrolysis of GlcNAc improved sensitivity to 75% at the expense of a specificity of 28%. Estimation of the relative abundance of GlcNH2 (GlcNH2%) or the ratio of GlcNH2 to endogenous mannose (Man) improved accuracy. In a further blind experiment the GlcNH2/Man ratio with a cut-off of 1.5 correctly identified all those receiving 'any breastmilk', while excluding exclusively formula fed infants. . The GlcNH2/Man ratio in infant urine is a promising test to provide biochemical confirmation of any breastfeeding for trials of breastfeeding promotion.

Original languageEnglish
Article numbere12859
Number of pages24
JournalMaternal and Child Nutrition
Early online date19 Jun 2019
Publication statusE-pub ahead of print - 19 Jun 2019


  • breast feeding
  • health promotion
  • programme evaluation
  • human milk
  • oligosaccharides
  • carbohydrate biochemistry


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