Lactation and Neonatal Nutrition: Defining and Refining the Critical Questions

Margaret C. Neville, Steven M. Anderson, James L. McManaman, Thomas M. Badger, Maya Bunik, Nikhat Contractor, Tessa Crume, Dana Dabelea, Sharon M. Donovan, Nicole Forman, Daniel N. Frank, Jacob E. Friedman, J. Bruce German, Armond Goldman, Darryl Hadsell, Michael Hambidge, Katie Hinde, Nelson D. Horseman, Russell C. Hovey, Edward Janoff, Nancy F. Krebs, Carlito B. Lebrilla, Danielle G. Lemay, Paul S. MacLean, Paula Meier, Ardythe L. Morrow, Josef Neu, Laurie A. Nommsen-Rivers, Daniel J. Raiten, Monique Rijnkels, Victoria Seewaldt, Barry D. Shur, Joshua VanHouten, Peter Williamson

This paper resulted from a conference entitled "Lactation and Milk: Defining and refining the critical questions" held at the University of Colorado School of Medicine from January 18-20, 2012. The mission of the conference was to identify unresolved questions and set future goals for research into human milk composition, mammary development and lactation. We first outline the unanswered questions regarding the composition of human milk (Section I) and the mechanisms by which milk components affect neonatal development, growth and health and recommend models for future research. Emerging questions about how milk components affect cognitive development and behavioral phenotype of the offspring are presented in Section II. In Section III we outline the important unanswered questions about regulation of mammary gland development, the heritability of defects, the effects of maternal nutrition, disease, metabolic status, and therapeutic drugs upon the subsequent lactation. Questions surrounding breastfeeding practice are also highlighted. In Section IV we describe the specific nutritional challenges faced by three different populations, namely preterm infants, infants born to obese mothers who may or may not have gestational diabetes, and infants born to undernourished mothers. The recognition that multidisciplinary training is critical to advancing the field led us to formulate specific training recommendations in Section V. Our recommendations for research emphasis are summarized in Section VI. In sum, we present a roadmap for multidisciplinary research into all aspects of human lactation, milk and its role in infant nutrition for the next decade and beyond.