Impact of processing techniques on donor human milk: a multi-omics and bioinformatics scoping review

Introduction: Mothers' milk is the optimal source of nutrition for infants. When unavailable, pasteurized donor human milk (PDHM) is the recommended alternative, particularly for premature neonates at a risk of food insecurity. However, processing methods, such as pasteurization, can alter the nutritional and bioactive composition of milk. This scoping review synthesizes current evidence from multi-omics technologies and bioinformatics to characterize the biochemical impact of processing on PDHM and identify knowledge gaps. Methods: A systematic literature search was conducted using five databases (Medline, EMBASE, Scopus, LILACS, and Web of Science) in accordance with the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines. Observational and descriptive studies characterizing the proteome, glycome, lipidome, or metabolome of pasteurized milk using high-resolution analytical techniques such as mass spectrometry or nuclear magnetic resonance spectroscopy were included. Of 304 articles screened, 18 met the inclusion criteria. Results: The processing effects varied markedly depending on the biomolecule and the technique. Holder pasteurization (HoP), the most widely used method, causes substantial degradation of key immune proteins (e.g., IgA and lactoferrin) and enzymes. In contrast, human milk oligosaccharides (HMOs) and trace elements remained relatively stable. Alternative methods, including high-temperature short-time (HTST) pasteurization and high-pressure pasteurization (HPP), more effectively preserve the bioactive components. Notably, HoP promotes the formation of Maillard reaction products and advanced glycation end products (AGEs), which may have detrimental biological effects. Conclusion: Multi-omics analyses highlighted a critical trade-off between microbiological safety and the preservation of bioactive integrity in PDHM, particularly with HoP. These technologies are essential for quantifying processing-induced alterations and for guiding the development of improved preservation strategies. Such approaches are pivotal for implementing precise nutritional interventions aimed at optimizing health outcomes in vulnerable neonatal populations.