모유 수유 산모의 영양상태가 모유 영양성분에 미치는 영향: 최근 10년 문헌의 통합적 분석 = The Influence of Maternal Nutritional Status on Breast Milk Composition: An Integrative Analysis of Studies Published in the Past Ten Years

다국어 초록 (Multilingual Abstract)

This integrative review aimed to systematically examine the relationship between maternal nutritional status and the composition of human breast milk based on studies published over the past ten years, and to evaluate the level of evidence according to specific nutrients. The review was conducted in accordance with the PRISMA guidelines. Relevant articles were identified through major academic databases, followed by duplicate removal and multi-step screening, resulting in the inclusion of a total of 28 studies. The included studies were conducted across diverse regions, including North America, Europe, Asia, and Oceania, and comprised cross-sectional studies, prospective cohort studies, randomized controlled trials (RCTs), observational studies, intervention studies, as well as a limited number of systematic reviews and meta-analyses. Breast milk components were analyzed using various analytical techniques, including liquid chromatography(LC), gas chromatography (GC), and mass spectrometry (MS). The findings indicated that maternal intake and nutritional status of specific nutrients were significantly associated with corresponding changes in breast milk composition. In particular, vitamin D and docosahexaenoic acid (DHA) consistently showed positive associations, with increased maternal dietary intake or supplementation leading to higher concentrations in breast milk. These relationships were repeatedly confirmed in RCTs, suggesting a relatively high level of evidence for these nutrients. In contrast, folate and vitamin B12 exhibited substantial heterogeneity across studies, largely due to differences in measurement methods, supplementation practices, and national nutrition policies, which limited the ability to draw consistent conclusions. Iron and calcium concentrations in breast milk remained relatively stable; however, maternal deficiency risk varied markedly depending on regional and dietary contexts. Analysis by study design demonstrated that RCTs provided stronger and more consistent evidence for vitamin D and DHA, whereas most micronutrients relied primarily on observational data. Differences in analytical methods influenced reported concentration values and variability, particularly for fatty acids and certain micronutrients, underscoring the need for caution when comparing results across studies. Regional analysis revealed variations in research focus and design, with intervention studies predominating in North America and observational studies more common in Europe and Asia. In conclusion, this integrative review confirmed that maternal nutritional status exerts relatively direct and predictable effects on specific breast milk components, particularly vitamin D and DHA. Conversely, nutrients such as folate, vitamin B12, iron, and calcium appeared to be more strongly influenced by long-term nutritional status and physiological homeostasis rather than short-term dietary changes. These findings provide evidence-based support for postpartum nutrition education, clinical nutritional interventions, and public health policy development, and highlight the need for standardized analytical protocols and large-scale, multicenter cohort and intervention studies to strengthen causal evidence across nutrients.