Direct measurement and estimation of the energy content of human milk

Abstract Human milk is a highly variable composite fluid that has a dynamic nutrient composition. The energy content of human milk can be both directly and indirectly measured. The accuracy of the measurement is influenced by the sampling and analytical methods employed. The applicability of the measurement depends on whether it is an estimation of gross or metabolizable energy. The literature reporting the energy content of human milk is mixed and varied. Several organizations recommend the use of metabolizable energy for food labeling and thus recommend for all foods the rounded off Atwater figures of 4, 4, and 9 kcal/g (17, 17, and 37 kJ/g) to calculate the metabolizable energy contributions of protein, metabolizable carbohydrate, and fat, respectively. To be consistent with food composition tables and conventions in nutrition science, metabolizable energy, not gross energy, should be estimated for human milk.

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