# Evaluating the Effect of Random Multi‐Donor Pooling on the Nutritional Variability in Donor Human Milk Using Computer Modeling

## TL;DR

This study uses computer modeling to show that combining more donors in human milk pools reduces variability in key nutrients like protein and fat, but not for many vitamins and minerals.

## Contribution

The study introduces a computer modeling approach to evaluate the impact of donor pooling on DHM nutritional variability.

## Key findings

- Random pooling of 5+ donors reduces variability in fat and true protein to a Nutrient Inequality Index (NII) of less than 1.3.
- Micronutrients like zinc and iron show high variability (NII >1.5) even with 10 donors per pool.
- Lactose variability stabilizes at an NII of less than 1.1 with 3+ donors per pool.

## Abstract

Protein and fat concentrations in donor human milk (DHM) can vary twofold to threefold and are influenced by the number of unique donors per pool. The aim of this study was to broadly characterize how the number of donors (2–10) randomly combined into a pool during milk bank processing influenced the variability of macronutrients, vitamins, minerals, and bioactive factors in DHM. The minimum number of donors required for 80% of the pools to meet pre‐defined targets for true protein, fat, and disialyllacto‐N‐tetraose (DSLNT) was also evaluated. Monte Carlo simulation was used to create models that accounted for donor lifetime donation volume and milk bank production constraints. Variability in nutrients was quantified as a Nutrient Inequality Index (NII) which was computed as the ratio of the 90th percentile to the 10th percentile for each simulation. Random multi‐donor pooling of 2–10 donors produced lower variability in DHM macronutrients than most vitamins and minerals. A priori targets of 0.9 g/dL of true protein, 3.5 g/dL of fat, and 210 µg/L of DSLNT could not be achieved with any random pooling scenario. The NII for lactose stabilized at less than 1.1 when there were 3+ donors per pool, while the NII for fat and true protein stabilized at less than 1.3 when there were 5+ donors per pool. The NII exceeded 1.5, even at 10 donors per pool, for several micronutrients including zinc, copper, sodium, iron, biotin, riboflavin, B6, B12, and pantothenic acid.

Donor human milk (DHM) macronutrient composition has been reported to vary by twofold or higher, and there is a dearth of information on micronutrient composition.Emerging evidence suggests that random multi‐donor pooling may be an effective strategy for milk banks to reduce nutritional variations in DHM.Random multi‐donor pooling of 2–10 donors produced lower variability in lactose, fat, and true protein, than most vitamins and minerals.At 5 to 10 donors per pool, several micronutrients varied by 1.5 to 2.0‐fold including zinc, sodium, iron, copper, thiamin, B6, B12, biotin, and panthothenic acid.

Donor human milk (DHM) macronutrient composition has been reported to vary by twofold or higher, and there is a dearth of information on micronutrient composition.

Emerging evidence suggests that random multi‐donor pooling may be an effective strategy for milk banks to reduce nutritional variations in DHM.

Random multi‐donor pooling of 2–10 donors produced lower variability in lactose, fat, and true protein, than most vitamins and minerals.

At 5 to 10 donors per pool, several micronutrients varied by 1.5 to 2.0‐fold including zinc, sodium, iron, copper, thiamin, B6, B12, biotin, and panthothenic acid.