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A comparison of macronutrient-based methods for deriving energy values in human milk



Energy values for human milk are increasingly available clinically, though there are no standards for deriving these values. We compared published calorie methods using a common set of samples.

Study design

Ten human milk samples were measured for gross and digestible macronutrients using laboratory methods. Four calorie conversion factors were used: Atwater general (ATW-GEN); Atwater milk specific (ATW-MILK), human milk specific (HUM-MILK), and combustible conversions (COMBUST). Differences in derived calories were assessed using ANOVA.


There was a significant difference (P < 0.001) in calorie values between methods. Gross macronutrients with COMBUST conversion factors produced the highest calorie values (19.4 ± 1.4 kcal/ounce) whereas digestible macronutrients with HUM-MILK conversion factors produced the lowest calorie values (16.3 ± 1.3 kcal/ounce). Mean difference between these values was 3.1 kcal/ounce (95% CI 2.5, 3.7).


Mean calorie difference of 3.1 kcal/ounce is clinically important for preterm infants, suggesting the need for standardization.

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Fig. 1: Computed energy values using gross and digestible macronutrients and multiple calorie conversion factors.


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MTP received research gifts from Mothers’ Milk Bank of North Texas, Northwest Mothers Milk Bank, and NorthernStar Mothers Milk Bank which were used to support this study.

Author information




MTP conceived of the study. LB and MTP collected study data. MBB, LB, MGP, EHS, and MTP analyzed and interpreted study data; MTP drafted the original manuscript; all authors edited and approved the final manuscript.

Corresponding author

Correspondence to Maryanne T. Perrin.

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Conflict of interest

MTP serves on the Board of Directors for the Human Milk Banking Association of North America in an unpaid capacity. EHS serves on the Board of Directors and as Medical Director in an unpaid capacity for the Mother’s Milk Bank of North Texas. MBB and MGP are volunteer members of the Research Advisory Board for Mother’s Milk Bank Northeast. MBB has previously received research grant funding from and served as a consultant to Miris AB (Uppsala, Sweden) for an unrelated project. LB is UC San Diego Chair of Collaborative Human Milk Research, endowed by the Family Larsson-Rosenquist Foundation, and serves on the foundation’s scientific advisory board. LB is (co-)inventor on patent applications regarding human milk oligosaccharides in prevention of necrotizing enterocolitis and other inflammatory disorders.

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Perrin, M.T., Spence, E.H., Belfort, M.B. et al. A comparison of macronutrient-based methods for deriving energy values in human milk. J Perinatol 40, 1688–1693 (2020).

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