{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T21:34:45Z","timestamp":1773696885743,"version":"3.50.1"},"reference-count":58,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T00:00:00Z","timestamp":1753833600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>This review aimed to be comprehensive and to critically analyze the factors that may affect the macronutrient and energy content of breast milk. Systematic reviews were prioritized, even though other types of literature reviews on the subject, as well as studies not included in these reviews, were included. Reported factors that potentially affect the macronutrient and energy content of breast milk comprise: maternal factors, such as age, nutritional status, dietary intake, smoking habits, lactation stage, circadian rhythmicity, and the use of galactagogues; obstetrical factors, such as parity, preterm delivery, multiple pregnancies, labor and delivery, and pregnancy morbidities including intrauterine growth restriction, hypertensive disorders, and gestational diabetes mellitus; and newborn factors, including sexual dimorphism, and anthropometry at birth. Some factors underwent a less robust assessment, while others underwent a more in-depth analysis. For example, the milk from overweight and obese mothers has been reported to be richer in energy and fat. A progressive decrease in protein content and an increase in fat content was described over time during lactation. The milk from mothers with hypertensive disorders may have a higher protein content. Higher protein and energy content has been found in early milk from mothers who delivered prematurely.<\/jats:p>","DOI":"10.3390\/nu17152503","type":"journal-article","created":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T14:00:41Z","timestamp":1753884041000},"page":"2503","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Factors That May Affect Breast Milk Macronutrient and Energy Content: A Critical Review"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-0332-2985","authenticated-orcid":false,"given":"In\u00eas","family":"Rocha-Pinto","sequence":"first","affiliation":[{"name":"Faculdade de Ci\u00eancias da Nutri\u00e7\u00e3o e Alimenta\u00e7\u00e3o da Universidade do Porto, 4150-180 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6480-1048","authenticated-orcid":false,"given":"Lu\u00eds","family":"Pereira-da-Silva","sequence":"additional","affiliation":[{"name":"Neonatology Unit, Department of Pediatrics, Hospital Dona Estef\u00e2nia, Unidade Local de Sa\u00fade S\u00e3o Jos\u00e9, 1169-045 Lisbon, Portugal"},{"name":"Medicine of Woman, Childhood and Adolescence Academic Area, NOVA Medical School, Universidade Nova de Lisboa, 1169-056 Lisbon, Portugal"},{"name":"CHRC\u2014Comprehensive Health Research Centre, Nutrition Group, NOVA Medical School, Universidade Nova de Lisboa, 1169-056 Lisbon, Portugal"}]},{"given":"Diana e","family":"Silva","sequence":"additional","affiliation":[{"name":"Faculdade de Ci\u00eancias da Nutri\u00e7\u00e3o e Alimenta\u00e7\u00e3o da Universidade do Porto, 4150-180 Porto, Portugal"}]},{"given":"Manuela","family":"Cardoso","sequence":"additional","affiliation":[{"name":"Neonatology Unit, Department of Pediatrics, Maternidade Dr. Alfredo da Costa, Unidade Local de Sa\u00fade S\u00e3o Jos\u00e9, 1069-089 Lisbon, Portugal"},{"name":"Nutrition Unit, Maternidade Dr. Alfredo da Costa, Unidade Local de Sa\u00fade S\u00e3o Jos\u00e9, 1069-089 Lisbon, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e2118904","DOI":"10.1001\/jamanetworkopen.2021.18904","article-title":"Assessment of neonatal intensive care unit practices, morbidity, and mortality among very preterm infants in China","volume":"4","author":"Cao","year":"2021","journal-title":"JAMA Netw. 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