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Despite recommendations from the World Health Organization and the American Academy of Pediatrics to exclusively breastfeed infants for their first 6 months of life, 75% of women do not meet exclusive breastfeeding guidelines, and 60% do not meet their own breastfeeding goals. Numerous observational studies have linked maternal psychological distress (eg, perceived stress, anxiety, and depression) with nonoptimal breastfeeding outcomes, such as decreased proportion and duration of exclusive breastfeeding. The physiological mechanisms underlying these associations, however, remain unclear. For this narrative review, we evaluated the evidence of relationships between maternal psychological distress and lactation and breastfeeding outcomes in pregnancy and post partum and the possible physiological mechanisms that facilitate these relationships. We searched PubMed using the following terms: stress, anxiety, depression, breastfeeding, and lactation. Additional search by hand was conducted to ensure a thorough review of the literature. Among the studies examined, methods used to assess maternal psychological distress were not uniform, with some studies examining perceived distress via a variety of validated tools and others measuring biological measures of distress, such as cortisol. Evidence supports a role for psychological distress in multiple breastfeeding outcomes, including delayed secretory activation and decreased duration of exclusive breastfeeding. One physiological mechanism proposed to explain these relationships is that psychological distress may impair the release of oxytocin, a hormone that plays a critical role in milk ejection during lactation. Continued impairment of milk ejection may lead to decreased milk production because of incomplete emptying of the breast during each feed. Maternal distress may also yield elevated levels of serum cortisol and decreased insulin sensitivity, which are associated with decreased milk production. The relationship between psychological distress and breastfeeding is likely to be bidirectional, however, in that breastfeeding appears to reduce maternal distress, again possibly via effects on the pleasure or reward pathway and calming effects of oxytocin on the mother. This finding suggests that interventions to support lactation and breastfeeding goals in women who score high on measures of psychological distress would be beneficial for both maternal and infant well-being. Evidence to date suggests that maternal psychological distress may impair lactation and breastfeeding outcomes, but stronger study designs and rigorous assessment methods are needed. A better understanding of the physiological mechanisms leading to impaired lactation may assist in the development of early interventions for mothers experiencing distress. In addition, stress-reducing programs and policies should be investigated for their potential to improve breastfeeding outcomes.

The establishment of the gut microbiome in early life is critical for healthy infant development. Although human milk is recommended as sole nutrition for the infant, little is known about how variation in the milk microbiome shapes the microbial communities in the infant gut. Here, we quantified the similarity between the maternal milk and the infant gut microbiomes using 507 metagenomic samples collected from 195 mother-infant pairs at one, three, and six months postpartum. Microbial taxonomic overlap between milk and the infant gut was driven by Bifidobacterium longum , and infant microbiomes dominated by B. longum showed greater temporal stability than those dominated by other species. We identified numerous instances of strain sharing between milk and the infant gut, involving both commensal (e.g. B. longum ) and pathobiont species (e.g. K. pneumoniae ). Shared strains also included typically oral species such as S. salivarius and V. parvula , suggesting possible transmission from the infant’s oral cavity to the mother’s milk. At one month, the infant gut microbiome was enriched in biosynthetic pathways, suggesting that early colonisers might be more metabolically independent than those present at six months. Lastly, we observed significant overlap in antimicrobial resistance gene carriage within mother-infant pairs. Together, our results suggest that the human milk microbiome has an important role in the assembly, composition, and stability of the infant gut microbiome. Here, with metagenomic analyses on longitudinal samples collected from 195 mother-infant pairs, the authors show that the breast milk microbiome contributes to infant gut assembly through bacterial strain sharing and antimicrobial resistance gene overlap during the first six months of life.

•Gestational Diabetes Mellitus is associated with reduced abundance of human milk exosomal microRNAs involved in important metabolic processes.•Highly abundant microRNAs in breast milk (miR-148a and miR-30b) are associated with infant growth and adiposity early in infancy.•Higher maternal diet quality is associated with increased abundance of each of measured miRNAs (miR-148a, miR-30n, miR-let-7a and miR-let-7d).•Human Milk miRNAs may be a therapeutic target to mitigate risk of metabolic outcomes in offspring of women with gestational diabetes mellitus. Human milk (HM) is a unique biological fluid that is enriched with a variety of factors, including microRNAs (miRNAs) that potentially provide both short- and long-term benefits to the infants. miRNAs are packaged within exosomes, making them bioavailable to infants. Gestational diabetes mellitus (GDM) may affect the abundance of exosomal miRNAs in HM, providing a mechanism for growth and adiposity variation in infants of mothers with GDM in early life. Therefore, the purposes of this study were to examine the impact of GDM on select miRNAs (miRNA-148a, miRNA-30b, miRNA-let-7a, and miRNA-let-7d) involved in metabolism and to examine the association of these miRNAs with measures of infant body composition in the first 6 months of life. Milk samples were collected from a cohort of 94 mothers (62 mothers without GDM and 32 mothers with GDM) matched on body mass index strata at 1 month post partum. miRNA abundance was measured by real-time polymerase chain reaction. Linear regression models were used to examine potential differences in miRNA abundance in women with and without GDM, testing associations between miRNA abundance and infant growth and body composition measures from 1 to 6 months. The abundances of miRNA-148a, miRNA-30b, miRNA-let-7a, and miRNA-let-7d were reduced in milk from mothers with GDM. Independent of GDM status, higher maternal diet quality was associated with increased abundance of each of the measured miRNAs. miRNA-148a was negatively associated with infant weight, percentage of body fat, and fat mass, whereas miRNA-30b was positively associated with infant weight and fat mass at 1 month of age. There was no association of milk miRNA-148a and miRNA-30b with infant weight at 1 month of age or with body composition measures at 3 months of age; however, miRNA-148a was negatively associated with infant weight at 6 months of age. If supported by randomized dietary supplementation or other intervention trials, HM miRNAs may be a therapeutic target to mitigate risk of metabolic outcomes in offspring of women with GDM.

Human cytomegalovirus (CMV) is a highly prevalent herpesvirus that is often transmitted to the neonate via breast milk. Postnatal CMV transmission can have negative health consequences for preterm and immunocompromised infants, but any effects on healthy term infants are thought to be benign. Furthermore, the impact of CMV on the composition of the hundreds of bioactive factors in human milk has not been tested. Here, we utilize a cohort of exclusively breastfeeding full-term mother-infant pairs to test for differences in the milk transcriptome and metabolome associated with CMV, and the impact of CMV in breast milk on the infant gut microbiome and infant growth. We find upregulation of the indoleamine 2,3-dioxygenase (IDO) tryptophan-to-kynurenine metabolic pathway in CMV+ milk samples, and that CMV+ milk is associated with decreased Bifidobacterium in the infant gut. Our data indicate two opposing CMV-associated effects on infant growth; with kynurenine positively correlated, and CMV viral load negatively correlated, with infant weight-for-length at 1 month of age. These results suggest CMV transmission, CMV-related changes in milk composition, or both may be modulators of full-term infant development. Cytomegalovirus (CMV) is often transmitted to infants through breast milk. Here, in a cohort of exclusively breastfeeding full-term mother-infant pairs, the authors identify changes in milk composition, infant growth, and the infant gut microbiome associated with the presence of CMV in milk.

The objective of this study was to investigate the associations of mode of feeding with infant anthropometric and body composition variables at 6 months of age. We studied 259 infants whose exclusive mode of feeding (breast or formula) to 1 month was confirmed. Standard anthropometric characteristics of the infants (weight, length and weight‐for‐length z scores) were obtained, and body composition (total fat mass, fat‐free mass, trunk fat mass and body fat percent) was measured using dual‐energy X‐ray absorptiometry (DXA) at 6 months (±12 days). General linear models were used to test the associations of mode of feeding with infant anthropometric and body composition variables at 6 months after adjustment for maternal and infant covariates. In this cohort of predominantly breastfed, White infants of highly educated mothers, fat‐free mass was lower (P = .002), and trunk fat mass (P = .032) and body fat percent (P < .001) were greater in breastfed infants than in formula‐fed infants at 6 months of age. After adjustment for covariates, total fat‐free mass was significantly lower (β = −372 g, [SE = 125, P = .003]), and body fat percent was significantly greater (β = 3.30, [SE = 0.91, P < .001]) in breastfed infants than in formula‐fed infants. No other significant associations were observed. These findings support those of previous studies reporting greater fat‐free mass in formula‐fed infants during the first 6 months of life. Additional research is warranted to explore whether differences in infant body composition by mode of feeding persist throughout the life course and to assess causality.

This deeply insightful guide to understanding what clients really want is \"an indispensable resource for consultants\" (Keith Ferrazzi, #1 New York Times-bestselling author of Never Eat Alone). Independent consulting is a potentially lucrative enterprise—but the reality seldom matches the dream. Most solo consultants and boutique consulting firms are perpetually within six months of bankruptcy due to the sputtering unreliability of their new business engines. The problem, according to international consulting expert David A. Fields, is twofold: 1) lack of a consistent, proven plan, and 2) fundamental misunderstanding about what clients want in a consultant. Fields, who has helped hundreds of consultants and boutique firms worldwide build profitable, sustainable practices, replaces the typical consultant's mindset of emphasizing expertise and differentiated processes with a focus on building relationships, engendering trust, and solving clients' existing problems. In The Irresistible Consultant's Guide to Winning Clients, Fields synthesizes his decades of experience into a step-by-step approach to winning more projects from more clients at higher fees. From nuts-and-bolts business advice and tactics to a deeply insightful breakdown of the human side of a very human profession, Fields, named one of Advertising Age magazine's \"Marketing Top 100,\" delivers a comprehensive guidebook that is at once highly approachable and satisfyingly detailed. \"If I could have just one book on client strategy, this book would be it.\" —Marshall Goldsmith, #1 New York Times–bestselling author of Triggers

Background: Dual-energy x-ray absorptiometry (DXA) provides an affordable and practical assessment of multiple whole body and regional body composition. However, little information is available on the assessment of changes in body composition in top-level athletes using DXA. The present study aimed to assess the accuracy of DXA in tracking body composition changes (relative fat mass [%FM], absolute fat mass [FM], and fat-free mass [FFM]) of elite male judo athletes from a period of weight stability to prior to a competition, compared to a four compartment model (4C model), as the criterion method. Methods: A total of 27 elite male judo athletes (age, 22.2 +/- 2.8 yrs) were evaluated. Measures of body volume by air displacement plethysmography, bone mineral content assessed by DXA, and total-body water assessed by deuterium dilution were used in a 4C model. Statistical analyses included examination of the coefficient of determinant (r2), standard error of estimation (SEE), slope, intercept, and agreement between models. Results: At a group level analysis, changes in %FM, FM, and FFM estimates by DXA were not significantly different from those by the 4C model. Though the regression between DXA and the 4C model did not differ from the line of identity DXA %FM, FM, and FFM changes only explained 29%, 36%, and 38% of the 4C reference values, respectively. Individual results showed that the 95% limits of agreement were -3.7 to 5.3 for %FM, -2.6 to 3.7 for FM, and -3.7 to 2.7 for FFM. The relation between the difference and the mean of the methods indicated a significant trend for %FM and FM changes with DXA overestimating at the lower ends and underestimating at the upper ends of FM changes. Conclusions: Our data indicate that both at group and individual levels DXA did not present an expected accuracy in tracking changes in adiposity in elite male judo athletes.

The correct assessment of energy expenditure in very active individuals is important to ensure that dietary energy intake is sufficient. We aimed to validate a combined heart rate (HR) and motion sensor in estimating total (TEE) and activity energy expenditure (AEE) in males and females with high physical activity levels. Cross-sectional. Doubly-labelled water (DLW) was used to assess 7-day TEE in 12 male and female elite junior basketball players, aged 16–17 years. Resting energy expenditure (REE) was assessed with indirect calorimetry and AEE was calculated (AEE=TEE-RMR-0.1×TEE). Simultaneously, TEE and AEE were measured by combined HR and motion sensing. Individual HR calibration was performed with step-test. TEE and AEE were estimated from accelerometry and HR with individual (ACC+HRstep) and group calibration (ACC+HRgroup). No mean differences were found between TEE and AEE from the ACC+HRstep and ACC+HRgroup with DLW. TEE values (kJ/day) from ACC+HRgroup and ACC+HRstep explained TEE from DLW by ∼60% and 53%, respectively whereas AEE (kJ/day) estimated by ACC+HRgroup and ACC+HRstep explained 53% and 41% of the variability of AEE from the reference method. Concordance correlation coefficients for TEE and AEE using ACC+HRgroup were 0.74 and 0.69, correspondingly while for ACC+HRstep values of 0.69 and 0.45 were found. Large limits of agreement were found for TEE and AEE using both ACC+HRgroup and ACC+HRstep. ACC+HR models are a valid alternative to estimate TEE but not AEE in a group of highly active individuals however the considerable rate of equipment failure (∼50%) limits its usefulness.