A sizeable contribution to breast milk research

Gates Foundation grant places U of M at forefront of global human milk research

It’s an exciting time for breast milk research at the U of M, thanks to a $6.5 million grant from the Bill & Melinda Gates Foundation.

Meghan Azad, an assistant professor in the department of pediatrics and child health at the U of M, was awarded the grant to establish the International Milk Composition (IMiC) Consortium that will analyze breast milk to better inform maternal and infant nutrition.

“We’re going to do a really comprehensive analysis of all the different components of milk,” said Azad, who was announced as the funding recipient in February.

This includes macronutrients such as fat, carbohydrates and protein as well as micronutrients, including vitamins and minerals.

Azad and her team will also study hormones, antibodies, enzymes and microbes.

“We’re learning a lot about milk in the last decade, about these non-nutrient factors that are important,” she said.

“We want to analyze them and look at them all together because I think that’s what’s been missing due to limited funding and a lack of multidisciplinary research.”

The sheer magnitude of the grant provides the opportunity for Azad and her colleagues to do just that.

The primary focus of the study will be on the relationship between breast milk composition and infant growth.

In high-income countries, researchers are primarily focused on the issue of obesity, while in developing countries, due to malnutrition or infection, infants may fail to grow to their full potential.

“It’s a major problem that we’re hoping to tackle,” said Azad. “Recognizing that breast milk is what ideally delivers nutrition as well as immune protection in that early period of life, we want to understand more about that.”


The research

As part of the project, the team will conduct a systematic review of previous research about breast milk and infant growth led by Sarah Reyes, a postdoctoral fellow in the Azad lab, and involve students from the department of food and human nutritional sciences.

The study will analyze breast milk from about 1,200 mother-infant pairs in four different low- or middle-income countries along with Canadian mother-infant pairs and establish comparisons.

The four countries of focus will be Tanzania, Nepal, Pakistan and Burkina Faso.

In each of the developing nations, a randomized trial is taking place in which maternal nutrition supplements are distributed among the recruited mothers to see if the supplement will improve the growth of the baby.

Researchers will also collect a milk sample for analysis by Azad’s team.

The first phase of the project will be collecting the milk samples. The study will be taking two samples — the first at two months and another at six months.

Azad said it is important to capture the variation over time because milk changes to match the baby’s needs as it grows.

The second phase of the project will be bringing researchers into the consortium who are experts in different components of milk to analyze the samples in several different laboratories.

This will include labs analyzing the human milk oligosaccharides — prebiotics for healthy gut bacteria — while separate labs measure nutrients and antibodies.

In the third phase, Azad’s team will work with data scientists, using artificial intelligence and machine learning to integrate the data and make sense of it all.

The goal is to have a better understanding about the composition and variability of human milk and its link to infant growth through what Azad called a “massive database of tremendous value” and a network of researchers working together, which could lead to “a very unique platform for further research beyond this three-year project.”


The grant

The ball started rolling toward the Gates Foundation grant when Azad attended a ceremony in Toronto, Ont., for the presentation of the 2017 Canada Gairdner Awards. The honours are awarded by the Gairdner Foundation to researchers conducting groundbreaking research anywhere in the world.

“Some people call it the baby Nobel Prize,” said Azad. “It is that calibre of research.”

Azad’s intent was to meet Cesar Victora, an epidemiologist from Brazil who was receiving an award for his work on breastfeeding.

After speaking with him, she met with other researchers, including one who was developing a proposal for the Gates Foundation for a study about infant nutrition.

Azad was invited to a planning meeting where she first met people from the foundation.

Other researchers she met were organizing a session at a nutrition conference about breast milk and she was asked to present.

Azad spoke about her breastfeeding research with the CHILD Cohort Study, a birth cohort study across four provinces in Canada investigating the development of asthma and allergies in individuals through their lives.

Members of the Gates Foundation attended the conference scouting the latest on breastfeeding research and approached Azad to learn more about her research.

“I think it was a combination of doing innovative research on human milk and being at the right place at the right time by getting myself into the room to network with key researchers in this field,” said Azad.

Sun-Eun Lee, a Gates Foundation program officer, highlighted Azad’s “seminal work on maternal nutrition, infant feeding, and human milk composition” and said “Her comprehensive and transdisciplinary approach to human milk composition and her capacity to create a collaborative environment to harmonize analytical methods and human milk data with multiple data and field-site scientists would be critical to the success of this grant.”

U of M assistant professor of community health sciences Nathan Nickel — who is a co-director of the new Manitoba Interdisciplinary Lactation Centre alongside Azad and Lauren Kelly — called Azad a “brilliant, exceptionally hard-working and dedicated human milk scientist” while highlighting the benefit of her research.

“Breastfeeding research and human milk research rarely gets this level of funding nor this level of coverage in the media,” he said.

“This type of funding will support research that will make a significant contribution to our understanding [of] the role that human milk plays in shaping maternal-child outcomes.”

He added that the work “further reinforces that [the U of M] is a world leader in health research. That we can leverage large grants like this and generate ground-breaking new knowledge.

“This also opens the door for recruiting the top talent to the [university] in terms of trainees [and] in terms of faculty.”

Azad is well suited to the task, said Nickel.

“She is inspirational in terms of her dedication to science, to generating knowledge that supports health and to training the next generation of scientists.”