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Effect of a probiotic infant formula on infections in child care centers: comparison of two probiotic agents.

OBJECTIVE: To investigate the effect of 2 different species of probiotics in preventing infections in infants attending child care centers. METHODS: A double-blind, placebo-controlled, randomized trial was conducted from December 1, 2000, to September 30, 2002, at 14 child care centers in the Beer-Sheva area of Israel in healthy term infants 4 to 10 months old. Infants were assigned randomly to formula supplemented with Bifidobacterium lactis (BB-12), Lactobacillus reuteri (American Type Culture Collection 55730), or no probiotics. Duration of feeding, including follow-up, for each participant was 12 weeks. All infants were fed only the assigned formula and were not breastfed due to parental decision before recruitment to the study. Probiotic or prebiotic food products or supplements were not allowed. Main outcome measures were number of days and number of episodes with fever (>38 degrees C) and number of days and number of episodes with diarrhea or respiratory illness. RESULTS: Participants (n = 201) were similar regarding gestational age, birth weight, gender, and previous breastfeeding. The controls (n = 60), compared with those fed B lactis (n = 73) or L reuteri (n = 68), had significantly more febrile episodes (mean [95% confidence interval]: 0.41 [0.28-0.54] vs 0.27 [0.17-0.37] vs 0.11 [0.04-0.18], respectively). The controls also had more diarrhea episodes (0.31 [0.22-0.40] vs 0.13 [0.05-0.21] vs 0.02 [0.01-0.05], respectively) and episodes of longer duration (0.59 [0.34-0.84] vs 0.37 [0.08-0.66] vs 0.15 [0.12-0.18] days, respectively). The L reuteri group, compared with BB-12 or controls, had a significant decrease of number of days with fever, clinic visits, child care absences, and antibiotic prescriptions. Rate and duration of respiratory illnesses did not differ significantly between groups. CONCLUSIONS: Child care infants fed a formula supplemented with L reuteri or B lactis had fewer and shorter episodes of diarrhea, with no effect on respiratory illnesses. These effects were more prominent with L reuteri, which was also the only supplement to improve additional morbidity parameters.

Bifidobacterium↗

Effects of the composition and caloric value of infant formulas on intake and hormone levels.

Seventy-six normal full-term infants have been observed from birth to the fourth month of life. Thirty-six were breast-fed; the others were fed four different feeds (conventional or adapted formulas) containing different amounts of calories, protein, fat, and carbohydrate. The control mechanism of volume intake appears to be well functioning in infants fed human milk and adapted formulas providing conventional calorie concentrations. The other formulas were associated with either a high BUN or high base insulin concentrations. It is concluded that uncontrolled amounts of milk should be fed only to breast-fed infants and those receiving adapted formulas but not to those fed formulas that provide high calorie or protein concentrations.

Animals↗

Energy balance, nitrogen balance, and growth in preterm infants fed expressed breast milk, a premature infant formula, and two low-solute adapted formulae.

Energy balance, nitrogen balance, and growth studies were done in 37 preterm infants (20 of very low birthweight) who were fed on expressed breast milk or on one of 3 formulae each of different composition, including a special premature formula and a highly adapted 'humanised' formula. The variability of breast milk composition was such that it would have been difficult to predict the infants' protein and energy intakes under normal nursing conditions. All measured parameters of nutritional performance were best in infants fed on the 'premature' formula and were reflected in greater weight gain, linear growth, and head growth. The nitrogen balance data suggest that the highly adapted formula, which had a protein content comparable with that of mature human milk, contained too little protein for small preterm infants.

Animals↗

Iodine content of infant formulas and iodine intake of premature babies: high risk of iodine deficiency.

As part of a study of thyroid function in premature babies, the iodine content of their mothers' breast milk, that of 32 formulas from different brands used in Spain, and that of 127 formulas used in other countries was determined. Breast milk contained more iodine--mean (SEM) 10 (1) microgram/dl--than most of the formulas, especially those for premature babies. Iodine intakes were therefore below the recommended daily amount (RDA) for newborns: babies of 27-30 weeks' gestational age took 3.1 (1.1) micrograms/day at 5 days of age and 29.8 (2.7) micrograms by 2 months of age. This problem is not exclusive to Spanish premature babies as the iodine content of many of the formulas on sale in other countries was also inadequate. It is concluded that preterm infants who are formula fed are at high risk of iodine deficiency.

Bottle Feeding↗

Genistein at a concentration present in soy infant formula inhibits Caco-2BBe cell proliferation by causing G2/M cell cycle arrest.

Fifteen percent of all U.S. infants are fed soy formulas containing up to 47 mg/L of isoflavones (>65% as genistin + genistein); thus, these infants' intestines are exposed to a high dose of genistein, a phytoestrogen and tyrosine kinase inhibitor. Little attention has been focused on genistein's impact on the developing intestine. We hypothesized that a high dose of genistein would inhibit intestinal cell growth. Caco-2BBe human intestinal cells were exposed to 0, 3.7, and 111 micro mol/L (0, 1, and 30 mg/L) genistein in DMEM + 0.5% fetal bovine serum for 24-48 h. Cell number, thymidine incorporation, apoptosis, and cell cycle analyses were performed. The low genistein concentration increased intestinal cell proliferation by 28% (P = 0.001), but did not affect cell number or caspase-3 activity compared to the control. Furthermore, the addition of ICI, an estrogen receptor antagonist, negated the proliferative effect of the low genistein. In contrast, the high genistein concentration reduced cell number by 40%, proliferation by 94%, and caspase-3 activity by 50% compared to the control (P < 0.05). Cell cycle analysis after 48 h exposure to high genistein revealed 37% of cells in G0/G1 and 35% in G2/M vs. 71% in G0/G1 and 17% in G2/M for the control and low genistein groups. Thus, a biphasic effect of genistein was seen with a low dose stimulating intestinal cell proliferation through the estrogen receptor, whereas a high dose of genistein inhibited intestinal cell proliferation and altered cell cycle dynamics. A high dose of genistein may potentially compromise intestinal growth.

Apoptosis↗

The absorption of iron as supplements in infant cereal and infant formulas.

The absorption of iron was measured from isotopically tagged salts used in supplementing infant cereals and as the iron supplement in cow's milk and soy-based formulas. Iron as sodium iron pryophosphate and ferric orthophosphate were poorly absorbed from infant cereal (mean, smaller than 1.0%) and thus are not dependable sources of iron to meet the nutritional needs of infants. Reduced iron of very small particle size and ferrous sulfate when added to cereal was absorbed to a greater extent (mean, 4.0% and 2.7% respectively). For technical reasons, these two forms of iron had not been added to commercial cereal products because of discoloration, distribution problems of the iron in the product, and shortened shelf life. Therefore, at the present time, iron supplementation of infant cereals with sodium iron pyrophosphate, ferric orthophosphate, and reduced iron of large particle size does not provide a predictable and available source of iron to meet the needs of infants. Supplemental iron as ferrous sulfate in milk- and soy-based formulas gave a mean absorption of 3.4% and 5.4%. The iron supplements in these formulas can essentially meet the needs for dietary iron of healthy infants.

Animals↗

Evaluation of the maillard reaction in infant formulas by means of front-face fluorescence.

Foods are complex mixtures of macro- and micronutrients, which interact, leading to oxidation, glycation, and hydrolysis upon heating (e.g., sterilization, cooking) and storage. Their nutritional quality and safety are consequently affected, justifying the need for accurate monitoring of the evolution of the food composition during processing and shelf life. Classical chromatographic analysis as well as newly proposed rapid methods based on fluorescence spectrometry analyses were applied on whey powder-based models and commercial samples (in powdered form and ultrahigh temperature [UHT] sterilized), some of which had been previously submitted to protein hydrolysis. These samples were incubated for 48 h at 60 degrees C to mimic accelerated storage. Fluorescence fingerprints addressing modifications in the product composition during processing were recorded and analyzed by chemometric methods. Carboxymethyllysine (Nepsilon-[carboxymethyl]lysine; CML) was measured using an ELISA method. Fluorescence, recorded in a front-face mode on intact samples, is very sensitive to pertinent physicochemical changes induced by heat treatment, formulation (the moisture level in powders, presence of vitamin C and iron), and storage. Similar trends were observed between powders' fluorescence and CML-for example, a strong effect of protein hydrolysis and increasing water content. Addition of vitamin C was associated with an antioxidant effect despite the presence of iron. Good calibration models were obtained for predicting CML from fluorescence spectra both in food models and in commercial samples, although more work is needed to obtain accurate and robust calibration models. Results show the potential of nondestructively applied fluorescence spectrometry for measuring CML in formulas, a rapid, simple, and cost-effective method to monitor formula quality.

Fluorescence↗

Three-year growth and developmental follow-up of very low birth weight infants fed own mother's milk, a premature infant formula, or one of two standard formulas.

A cohort of 40 very low birth weight (VLBW) infants was followed until they reached 3 years of age. These infants were originally part of a feeding trial in the early postnatal period whereby they were fed either their own mother's milk, a standard whey-predominant formula, a casein-predominant formula, or a premature formula. Those fed the latter formula grew significantly better while in the hospital and had no biochemical derangements. At 3 years of age, there were no significant intergroup differences with respect to growth or development. There was a positive correlation between head growth in hospital and weight at 3 years, but there were no other significant relationships between early postnatal growth and growth parameters at 3 years. Socioeconomic status was the only predictor of developmental scores at 3 years of age. No adverse effects from early metabolic acidosis or alterations of amino acid profiles during the neonatal period were detectable at 3 years of age. However, the small sample size of this study may have missed true differences in outcome measures at 3 years, and larger studies are required to examine these questions further.

Cohort Studies↗

American Academy of Pediatrics. Committee on Nutrition. Hypoallergenic infant formulas.

The American Academy of Pediatrics is committed to breastfeeding as the ideal source of nutrition for infants. For those infants who are formula-fed, either as a supplement to breastfeeding or exclusively during their infancy, it is common practice for pediatricians to change the formula when symptoms of intolerance occur. Decisions about when the formula should be changed and which formula should be used vary significantly, however, among pediatric practitioners. This statement clarifies some of these issues as they relate to protein hypersensitivity (protein allergy), one of the causes of adverse reactions to feeding during infancy.

Breast Feeding↗

Influence of components of infant formulas on in vitro iron, zinc, and calcium availability.

The effect of casein content and Ca concentration on Fe, Zn, and Ca dialyzability was assessed using a response surface design. Tested casein levels were 5.31-13.75 g/L (34.8-90.2% of total protein). Whey protein was added to complete 15.25 g/L total protein. Calcium levels were adjusted with calcium citrate within a range between 417.4 and 804.9 mg/L. Through the experimental design utilized, we found that of both assessed factors, only the casein content significantly influenced Fe and Zn dialyzability. Protein composition did not influence calcium dialyzability, and calcium concentration did not affect either Fe or Zn dialyzability. No effect of casein-Ca on iron, zinc, and calcium dialyzability was found. According to these results, whey-dominant formulas are less prone to hamper mineral availability, and are therefore suitable in order to improve iron and zinc availability.

Biological Availability↗

Infant formula distribution and advertising in pregnancy: a hospital survey.

A survey was conducted at a 526-bed community hospital in Rochester, New York, to determine the prevalence of formula advertising and distribution during pregnancy to 136 consecutive intrapartum patients. Women answered a questionnaire about their choice of infant feeding methods and prenatal exposure to formula advertising. Of those who received printed information on infant feeding, 78 percent reported that it was published by a formula company, and 65 percent recalled receiving offers for free formula during their pregnancy. The likelihood of having received such offers was the same in women who planned to breastfeed as in those who planned to formula feed. Thirty-eight percent of women obtained formula through a free offer before their infant's birth. Women who were privately cared for were more likely to have received offers for free formula (p < 0.001) than were women cared for in hospital-affiliated clinics. Ninety percent of women who received free formula prenatally reported their prenatal caregiver as a source of samples. Of samples that women obtained prenatally, 93 percent were from companies that advertise only indirectly through hospitals and physicians, whereas 7 percent were from companies that advertise directly to patients. The prevalence of formula company advertising during the prenatal care of women who deliver in this hospital is high. The continued participation of prenatal caregivers in promotion efforts of formula companies provides a negative or mixed message about the importance of breastfeeding and may be a barrier to its success.

Adult↗

Essential fatty acid deficiency associated with the use of a medium-chain-triglyceride infant formula in pediatric hepatobiliary disease.

Serum phospholipid fatty acid patterns were determined by gas chromatography in four infants with hepatobiliary disease receiving a formula with a high content of medium-chain-triglyceride (MCT) oil. All four infants demonstrated signs of essential fatty acid deficiency, characterized by decreased arachidonic acid and increased palmitoleic and oleic acids. All had substantial concentrations of the pathologic triene 5,8,11-eicosatrienoic acid. Three of four had decreased linoleic acid concentrations and abnormal ratios of triene to tetraene (5,8,11-eicosatrienoic acid: arachidonic acid), greater than 0.38. One patient may have experienced growth failure due to abnormal essential fatty acid status. Infants with the potential for fat malabsorption should only receive MCT-oil feedings with well above the generally recommended requirements for linoleic acid (3% of total caloric intake).

Cholestasis↗