Sexual Dimorphism in Preterm Milk: A Step Toward the Individualized Fortification of Mother’s Own Milk?
Abstract
1. Introduction
1.1. Feeding Preterm Infants with Mother’s Own Milk
1.2. Sexual Dimorphism in Macronutrient and Energy Content of Breast Milk
1.3. Other Factors That May Affect Breast Milk Composition
1.4. What Needs to Be Explored
2. Objective
3. Methods
3.1. Setting and Ethical Issues
3.2. Ethical and Legal Issues
3.3. Study Design and Participants
3.4. Breast Milk Analysis
- −
- In single pregnancies, between the milk from mothers of either male or female infants.
- −
- Between the milk from mothers of either singleton or twin male infants.
- −
- Between the milk from mothers of either singleton or twin female infants.
3.5. Statistical Analysis
4. Results
- −
- During the 3rd week postpartum, the milk for females had a higher mean (SD) fat and total energy content than the milk for males: 4.7 (1.2) vs. 3.5 (1.1) g/dL (p = 0.005), and 81.9 (12.4) vs. 67.4 (13.7) kcal/dL (p = 0.004), respectively (Table 1).
- −
- During the 4th week postpartum, the milk for females had a higher mean (SD) fat and true protein content than the milk for males: 4.9 (2.1) vs. 3.6 (0.6) g/dL (p = 0.026), and 1.4 (0.3) vs. 1.0 (0.3) kcal/dL (p = 0.038), respectively (Table 1).
- −
- During the 6th week postpartum, the milk for males had a higher mean (SD) true protein content than the milk for females: 1.3 (0.2) vs. 1.0 (0.2) g/dL (p = 0.005) (Table 1).
Postpartum Week | Nutrient | Milk Samples for Males and Females | Milk Content (g/100 mL) for Males, Mean (SD) | Milk Content (g/100 mL) for Females, Mean (SD) | p-Value |
---|---|---|---|---|---|
1st week | Total protein (g) | 35/38 | 2.21 (0.36) | 2.46 (1.03) | 0.173 |
True protein (g) | 35/38 | 1.75 (0.30) | 1.96 (0.82) | 0.153 | |
Fat (g) | 35/38 | 2.63 (1.28) | 2.86 (1.73) | 0.520 | |
CHO (g) | 35/38 | 7.55 (0.76) | 7.24 (1.02) | 0.153 | |
Energy (kcal) | 35/38 | 64.1 (12.73) | 67.2 (17.3) | 0.402 | |
2nd week | Total protein (g) | 39/33 | 1.75 (0.52) | 1.90 (0.43) | 0.180 |
True protein (g) | 39/33 | 1.40 (0.41) | 1.51 (0.35) | 0.220 | |
Fat (g) | 39/33 | 3.69 (1.53) | 3.90 (1.34) | 0.388 | |
COH (g) | 39/33 | 6.89 (1.42) | 7.35 (0.87) | 0.095 | |
Energy (kcal) | 39/33 | 66.9 (15.6) | 71.6 (10.6) | 0.150 | |
3rd week | Total protein (g) | 18/14 | 1.68 (0.59) | 1.79 (0.41) | 0.561 |
True protein (g) | 18/14 | 1.31 (0.35) | 1.44 (0.32) | 0.294 | |
Fat (g) | 18/14 | 3.46 (1.06) | 4.69 (1.22) | 0.005 | |
COH (g) | 18/14 | 7.08 (1.36) | 7.66 (0.35) | 0.100 | |
Energy (kcal) | 18/14 | 67.4 (13.7) | 81.9 (12.4) | 0.004 | |
4th week | Total protein (g) | 9/18 | 1.43 (0.38) | 1.71 (0.53) | 0.175 |
True protein (g) | 9/18 | 1.03 (0.30) | 1.37 (0.41) | 0.038 | |
Fat (g) | 9/18 | 3.59 (0.56) | 4.85 (2.09) | 0.026 | |
COH (g) | 9/18 | 7.26 (1.12) | 7.79 (0.95) | 0.097 | |
Energy (kcal) | 9/18 | 67.4 (6.89) | 83.4 (22.8) | 0.052 | |
5th week | Total protein (g) | 8/9 | 1.55 (0.56) | 1.27 (0.52) | 0.299 |
True protein (g) | 8/9 | 1.25 (0.42) | 1.02 (0.42) | 0.286 | |
Fat (g) | 8/9 | 4.21 (1.62) | 3.11 (1.74) | 0.198 | |
COH (g) | 8/9 | 7.73 (0.63) | 6.60 (2.17) | 0.085 | |
Energy (kcal) | 8/9 | 76.6 (16.49) | 61.3 (22.3) | 0.133 | |
6th week | Total protein (g) | 10/10 | 1.57 (0.26) | 2.14 (2.97) | 0.554 |
True protein (g) | 10/10 | 1.25 (0.19) | 0.98 (0.18) | 0.005 | |
Fat (g) | 10/10 | 3.73 (0.61) | 3.98 (1.17) | 0.561 | |
COH (g) | 10/10 | 7.62 (0.83) | 7.58 (0.49) | 0.897 | |
Energy (kcal) | 10/10 | 71.8 (6.6) | 72.6 (12.1) | 0.857 |
- −
- −
- A higher mean total protein, true protein, carbohydrate, and total energy content was found in the milk for male twins than in the milk for male singletons: 2.2 (0.4) vs. 1.8 (0.5) g/dL (p = 0.002) (Table 2), 1.8 (0.3) vs. 1.4 (0.4) g/dL (p = 0.002) (Table 3); 7.7 (0.8) vs. 6.9 (1.4) g/dL (p = 0.009) (Table 5); and 81.3 (19.5) vs. 67.0 kcal/dL (15.6) (p = 0.007) (Table 6), respectively.
- −
- −
- A higher mean (SD) true protein content was found in the milk for male twins than in the milk for male singletons: 1.4 (0.4) vs. 1.0 (0.3) g/dL (p = 0.024) (Table 3).
Milk for Males | Milk for Females | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
Singletons | Twins | Singletons | Twins | |||||||
Postpartum Week | Number of Samples | Total Protein (g/100 mL) Mean (SD) | Number of Samples | Total Protein (g/100 mL) Mean (SD) | p-Value | Number of Samples | Total Protein (g/100 mL) Mean (SD) | Number of Samples | Total Protein (g/100 mL) Mean (SD) | p-Value |
1st week | 35 | 2.21 (0.36) | 11 | 2.22 (0.49) | 0.961 | 38 | 2.46 (1.03) | 13 | 2.57 (1.37) | 0.743 |
2nd week | 39 | 1.75 (0.52) | 15 | 2.21 (0.35) | 0.002 | 33 | 1.90 (0.43) | 10 | 1.92 (0.56) | 0.906 |
3rd week | 18 | 1.68 (0.60) | 7 | 1.94 (0.32) | 0.290 | 14 | 1.79 (0.41) | 5 | 1.92 (0.48) | 0.574 |
4th week | 9 | 1.43 (0.38) | 8 | 1.78 (0.46) | 0.114 | 18 | 1.71 (0.53) | 6 | 1.48 (0.25) | 0.326 |
5th week | 8 | 1.55 (0.56) | 3 | 1.47 (0.15) | 0.811 | 9 | 1.27 (0.52) | 8 | 1.22 (0.48) | 0.867 |
6th week | 10 | 1.57 (0.26) | 2 | 1.35 (0.07) | 0.275 | 10 | 2.14 (2.98) | 2 | 1.65 (0.35) | 0.827 |
Milk for Males | Milk for Females | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
Singletons | Twins | Singletons | Twins | |||||||
Postpartum Week | Number of Samples | True Protein (g/100 mL) Mean (SD) | Number of Samples | True Protein (g/100 mL) Mean (SD) | p-Value | Number of Samples | True Protein (g/100 mL) Mean (SD) | Number of Samples | True Protein (g/100 mL) Mean (SD) | p-Value |
1st week | 35 | 1.75 (0.30) | 11 | 1.77 (0.39) | 0.828 | 38 | 1.96 (0.82) | 13 | 2.06 (1.10) | 0.728 |
2nd week | 39 | 1.40 (0.41) | 15 | 1.77 (0.30) | 0.002 | 33 | 1.51 (0.35) | 10 | 1.55 (0.46) | 0.781 |
3rd week | 18 | 1.31 (0.36) | 7 | 1.56 (0.26) | 0.104 | 14 | 1.44 (0.32) | 5 | 1.52 (0.37) | 0.633 |
4th week | 9 | 1.03 (0.30) | 8 | 1.44 (0.36) | 0.024 | 18 | 1.37 (0.41) | 6 | 1.22 (0.22) | 0.389 |
5th week | 8 | 1.25 (0.42) | 3 | 1.20 (0.10) | 0.849 | 9 | 1.02 (0.42) | 8 | 0.98 (0.39) | 0.815 |
6th week | 10 | 1.2 (0.20) | 2 | 1.10 (0.00) | 0.322 | 10 | 0.98 (0.18) | 2 | 1.30 (0.28) | 0.059 |
Milk for Males | Milk for Females | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
Singletons | Twins | Singletons | Twins | |||||||
Postpartum Week | Number of Samples | Fat Content (g/100 mL) Mean (SD) | Number of Samples | Fat Content (g/100 mL) Mean (SD) | p-Value | Number of Samples | Fat Content (g/100 mL) Mean (SD) | Number of Samples | Fat Content (g/100 mL) Mean (SD) | p-Value |
1st week | 35 | 2.63 (1.28) | 11 | 4.03 (1.69) | 0.005 | 38 | 2.86 (1.73) | 13 | 3.00 (1.70) | 0.802 |
2nd week | 39 | 3.43 (1.30) | 15 | 4.38(1.89) | 0.090 | 33 | 3.68 (1.04) | 10 | 4.62 (1.93) | 0.050 |
3rd week | 18 | 3.46 (1.06) | 7 | 4.49 (1.76) | 0.185 | 14 | 4.69 (1.22) | 5 | 5.04 (2.33) | 0.673 |
4th week | 9 | 3.59 (0.56) | 8 | 4.30 (1.32) | 0.162 | 18 | 4.85 (2.09) | 6 | 3.55 (0.80) | 0.156 |
5th week | 8 | 4.21 (1.62) | 3 | 4.17 (0.38) | 0.963 | 9 | 3.11 (1.74) | 8 | 4.26 (0.88) | 0.112 |
6th week | 10 | 3.73 (0.62) | 2 | 2.95 (0.78) | 0.144 | 10 | 3.98 (1.18) | 2 | 3.90 (0.14) | 0.928 |
Milk for Males | Milk for Females | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
Singletons | Twins | Singletons | Twins | |||||||
Postpartum Week | Number of Samples | Carbohydrates (g/100 mL) Mean (SD) | Number of Samples | Carbohydrates (g/100 mL) Mean (SD) | p-Value | Number of Samples | Carbohydrates (g/100 mL) Mean (SD) | Number of Samples | Carbohydrates (g/100 mL) Mean (SD) | p-Value |
1st week | 35 | 7.55 (0.759) | 11 | 7.51 (1.46) | 0.906 | 38 | 7.24 (1.02) | 13 | 7.11 (1.07) | 0.688 |
2nd week | 39 | 6.88 (1.41) | 15 | 7.73 (0.80) | 0.009 | 33 | 7.35 (0.87) | 10 | 7.62 (0.99) | 0.412 |
3rd week | 18 | 7.08 (1.37) | 7 | 7.49 (0.64) | 0.467 | 14 | 7.66 (0.35) | 5 | 7.90 (0.82) | 0.380 |
4th week | 9 | 7.02 (1.26) | 8 | 7.53 (0.97) | 0.374 | 18 | 7.77 (0.95) | 6 | 7.85 (1.04) | 0.857 |
5th week | 8 | 7.73 (0.63) | 3 | 6.93 (1.55) | 0.236 | 9 | 6.60 (2.17) | 8 | 7.61 (0.92) | 0.241 |
6th week | 10 | 7.62 (0.83) | 2 | 7.95 (0.64) | 0.613 | 10 | 7.58 (0.49) | 2 | 8.10 (0.14) | 0.182 |
Milk for Males | Milk for Females | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
Singletons | Twins | Singletons | Twins | |||||||
Postpartum Week | Number of Samples | Total Energy (g/100 mL) Mean (SD) | Number of Samples | Total Energy (g/100 mL) Mean (SD) | p-Value | Number of Samples | Total Energy (g/100 mL) Mean (SD) | Number of Samples | Total Energy (g/100 mL) Mean (SD) | p-Value |
1st week | 35 | 64.14 (12.73) | 11 | 77.0 (17.50) | 0.011 | 38 | 67.16 (17.28) | 13 | 67.31 (16.26) | 0.978 |
2nd week | 39 | 66.95 (15.58) | 15 | 81.26 (19.47) | 0.007 | 33 | 71.61 (10.61) | 10 | 81.7 (19.73) | 0.040 |
3rd week | 18 | 67.39 (13.70) | 7 | 80.14 (15.58) | 0.056 | 14 | 81.93 (12.40) | 5 | 86.80 (25.05) | 0.573 |
4th week | 9 | 67.44 (6.89) | 8 | 77.63 (16.27) | 0.106 | 18 | 83.39 (22.78) | 6 | 70.83 (6.46) | 0.202 |
5th week | 8 | 76.63 (16.49) | 3 | 73.00 (4.36) | 0.724 | 9 | 61.33 (22.32) | 8 | 75.13 (8.04) | 0.113 |
6th week | 10 | 71.80 (6.60) | 2 | 66.50 (3.54) | 0.307 | 10 | 72.60 (2.12) | 2 | 76.00 (1.41) | 0.711 |
5. Discussion
5.1. Differences in the Milk for Male and Female Preterm Singletons
5.2. Differences Between the Milk for Twins and the Milk for Singletons Within the Same Sex
5.3. Strengths and Limitations
5.4. The Practical Application of This Study’s Findings
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Rodrigues, I.; Proença, L.; Ramalho, R.; Virella, D.; Pereira-da-Silva, L.; Cardoso, M. Sexual Dimorphism in Preterm Milk: A Step Toward the Individualized Fortification of Mother’s Own Milk? Nutrients 2025, 17, 2644. https://doi.org/10.3390/nu17162644
Rodrigues I, Proença L, Ramalho R, Virella D, Pereira-da-Silva L, Cardoso M. Sexual Dimorphism in Preterm Milk: A Step Toward the Individualized Fortification of Mother’s Own Milk? Nutrients. 2025; 17(16):2644. https://doi.org/10.3390/nu17162644
Chicago/Turabian StyleRodrigues, Inês, Luís Proença, Renata Ramalho, Daniel Virella, Luís Pereira-da-Silva, and Manuela Cardoso. 2025. "Sexual Dimorphism in Preterm Milk: A Step Toward the Individualized Fortification of Mother’s Own Milk?" Nutrients 17, no. 16: 2644. https://doi.org/10.3390/nu17162644
APA StyleRodrigues, I., Proença, L., Ramalho, R., Virella, D., Pereira-da-Silva, L., & Cardoso, M. (2025). Sexual Dimorphism in Preterm Milk: A Step Toward the Individualized Fortification of Mother’s Own Milk? Nutrients, 17(16), 2644. https://doi.org/10.3390/nu17162644