{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T04:12:59Z","timestamp":1783656779961,"version":"3.55.0"},"reference-count":37,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T00:00:00Z","timestamp":1775433600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T00:00:00Z","timestamp":1775433600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000071","name":"National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["R01HD106391"],"award-info":[{"award-number":["R01HD106391"]}],"id":[{"id":"10.13039\/100000071","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["aspenjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Parenter Enteral Nutr"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Preterm infants frequently require human milk fortification to meet their unique nutrients requirements. How commercial fortifiers change essential macronutrients and micronutrients in donor human milk has not been well\u2010studied.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Our sampling frame included milk from approved United States milk bank donors (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009400), measured for macronutrients, vitamins, and minerals, and used to produce 1000 pools of donor milk. Fortification ratios were computed to describe the extent that fortifiers changed donor milk composition (&lt;100% indicates decreased; &gt;100% indicates increased). Intake ratios were computed to evaluate how unfortified and fortified donor milk at 160\u2009mL\/kg\/day compared to upper and lower preterm nutrient recommendations.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Fortifiers varied greatly in their impact on individual donor milk nutrients, with final macronutrient concentrations between 75% and 399% of unfortified values, while vitamin and mineral concentrations were between 50% and 800+% of unfortified values. Unfortified donor milk was able to meet the lower intake recommendations for three nutrients\u2014lactose, fat, and pantothenic acid\u2014highlighting the importance of utilizing multi\u2010nutrient fortifiers. Bovine\u2010derived fortifiers frequently did not meet lower targets for protein, choline, and several minerals, while human\u2010derived fortifiers did not meet lower targets for most B\u2010vitamins and choline, and exceeded some targets including protein, fat, calcium, phosphorus, and magnesium.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Fortification products available in the United States, when used with donor milk, frequently lead to both deficient and excessive nutrient intake compared to preterm enteral nutrition recommendations. Development of fortifier products based on robust nutritional reference values for donor milk is warranted to improve the nutritional care of preterm infants.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jpen.70089","type":"journal-article","created":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T03:03:21Z","timestamp":1775531001000},"page":"684-692","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Impact of fortifiers on donor milk nutrient composition: An experimental study"],"prefix":"10.1002","volume":"50","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2015-2066","authenticated-orcid":false,"given":"Kimberly","family":"Mansen","sequence":"first","affiliation":[{"name":"Integrated Maternal and Child Health and Development, PATH Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah","family":"Sanders","sequence":"additional","affiliation":[{"name":"Integrated Maternal and Child Health and Development, PATH Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah N.","family":"Taylor","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Yale School of Medicine New Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raven","family":"Dunstan","sequence":"additional","affiliation":[{"name":"Integrated Maternal and Child Health and Development, PATH Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3489-8213","authenticated-orcid":false,"given":"Kiersten","family":"Israel\u2010Ballard","sequence":"additional","affiliation":[{"name":"Integrated Maternal and Child Health and Development, PATH Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1645-8310","authenticated-orcid":false,"given":"Maryanne T.","family":"Perrin","sequence":"additional","affiliation":[{"name":"Department of Nutrition University of North Carolina Greensboro Greensboro North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,6]]},"reference":[{"key":"e_1_2_10_2_1","volume-title":"WHO Recommendations for Care of the Preterm or Low\u2010Birth\u2010Weight Infant","author":"World Health Organization","year":"2022"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2022-057092D"},{"key":"e_1_2_10_4_1","article-title":"Donor human milk for preventing necrotising enterocolitis in very preterm or very low\u2010birthweight infants","volume":"9","author":"Quigley M","year":"2024","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2021-054272"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2022-057988"},{"issue":"6","key":"e_1_2_10_7_1","article-title":"Multi\u2010nutrient fortification of human milk for preterm infants","volume":"6","author":"Brown JV","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"issue":"7","key":"e_1_2_10_8_1","article-title":"Formula versus donor breast milk for feeding preterm or low birth weight infants","volume":"7","author":"Quigley M","year":"2019","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/apa.15102"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/apa.14702"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2023.27693"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2017.10.005"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clp.2022.02.010"},{"key":"e_1_2_10_14_1","article-title":"Early fortification of human milk versus late fortification to promote growth in preterm infants","volume":"7","author":"Thanigainathan S","year":"2020","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_10_15_1","article-title":"Human milk\u2010derived fortifier versus bovine milk\u2010derived fortifier for prevention of mortality and morbidity in preterm neonates","volume":"2019","author":"Premkumar MH","year":"2019","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_10_16_1","article-title":"Individualized versus standard diet fortification for growth and development in preterm infants receiving human milk","volume":"11","author":"Fabrizio V","year":"2020","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2022.01.029"},{"key":"e_1_2_10_18_1","unstructured":"Prolacta Bioscience.Preterm Nutrition Products. 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