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Upper limits of iron in infant formulas.

Iron-fortified infant formula is effective in preventing iron deficiency at levels of iron that are compatible with an upper limit of 3 mg/100 kcal. However, lower levels of fortification may prove to be adequate. There are theoretical concerns about the effects of high levels of dietary iron on the absorption of other trace minerals and on resistance to infection. These considerations make it desirable to determine whether lower levels of iron fortification in infant formula will be equally effective in preventing iron deficiency in infants.

Anemia, Hypochromic↗

Retinal morphology and visual pigment levels in 6- and 12-month-old rhesus monkeys fed a taurine-free human infant formula.

Rhesus monkey infants were raised from birth until 6 or 12 months of age on a taurine-free soy protein-based human infant formula or on the same formula supplemented with taurine. An additional group received taurine-free formula until 6 months and then the supplemented diet from 6 until 12 months. The densities of rod and cone visual pigments were measured by fundus reflectometry at 6 and 12 months, and retinal morphology was then examined by light and electron microscopy. The densities of rhodopsin, measured in the near periphery after a white bleach, and of cone pigment, measured in the macula after a red bleach, were significantly reduced in the taurine-deprived monkeys at 6 months but not at 12 months. The retinas of 6-month-old taurine-deprived infants showed degenerative morphological changes in photoreceptors, particularly in cones in the foveal region, which were somewhat less severe than those seen in a previous study at 3 months of age. The prevalence and degree of these abnormalities continued to decrease with age in taurine-deprived animals, but changes persisted in some animals at 12 months. Recovery was more complete in monkeys reversed to the supplemented diet from 6 to 12 months. Thus, monkey infants are dependent on dietary taurine to maintain normal retinal structure until at least 6 months of age; the effects of taurine deprivation regress spontaneously but incompletely by 12 months.

Aging↗

The vitamin D content of fortified milk and infant formula.

BACKGROUND: The fortification of milk and infant formula with vitamin D has had an important role in eliminating rickets in children and osteomalacia in adults. A recent outbreak of vitamin D intoxication caused by drinking milk fortified with excess vitamin D has led to questions about the level of vitamin D in milk from other producers. METHODS: We used high-performance liquid chromatography to measure vitamin D in samples of 13 brands of milk with various fat contents and 5 brands of infant formula purchased at random from local supermarkets in five Eastern states. RESULTS: Only 12 (29 percent) of the 42 samples of the 13 brands of milk and none of the 10 samples of the 5 brands of infant formula contained 80 to 120 percent of the amount of vitamin D stated on the label. Twenty-six of the 42 milk samples (62 percent) contained less than 80 percent of the amount claimed on the label. No vitamin D was detected in 3 of the 14 samples of skim milk tested (lower limit of assay, 4.7 IU per quart [5.0 IU per liter]). One milk sample labeled as containing vitamin D2 (ergocalciferol) contained vitamin D3 (cholecalciferol). Seven of the 10 samples of infant formula contained more than 200 percent of the amount stated on the label; the sample with the highest concentration contained 419 percent of the stated amount. None of the samples of infant formula contained less than the amount stated. CONCLUSIONS: Milk and infant-formula preparations rarely contain the amount of vitamin D stated on the label and may be either underfortified or overfortified. Since both underfortification and overfortification are hazardous, better monitoring of the fortification process is needed.

Animals↗

Similar bifidogenic effects of prebiotic-supplemented partially hydrolyzed infant formula and breastfeeding on infant gut microbiota.

The aim of the study was to assess the quantitative and qualitative differences of the gut microbiota in infants. We evaluated gut microbiota at the age of 6 months in 32 infants who were either exclusively breast-fed, formula-fed, nursed by a formula supplemented with prebiotics (a mixture of fructo- and galacto-oligosaccharides) or breast-fed by mothers who had been given probiotics. The Bifidobacterium, Bacteroides, Clostridium and Lactobacillus/Enterococcus microbiota were assessed by the fluorescence in situ hybridization, and Bifidobacterium species were further characterized by PCR. Total number of bifidobacteria was lower among the formula-fed group than in other groups (P=0.044). Total amounts of the other bacteria were comparable between the groups. The specific Bifidobacterium microbiota composition of the breast-fed infants was achieved in infants receiving prebiotic supplemented formula. This would suggest that early gut Bifidobacterium microbiota can be modified by special diets up to the age of 6 months.

Bacteroides↗

A comparison of the relative acidogenic potential of infant milk and soya infant formula: a plaque pH study.

Soya infant formulas contain glucose syrups instead of lactose, which has led to concern that they are potentially more cariogenic than standard infant milk formulas, which contain lactose. However, the cariogenic potential of soya infant formulas has not been tested. The aim of this study was, therefore, to compare the effect of a soya infant formula and an infant milk on the pH of dental plaque. The study group consisted of 19 adults in whom plaque pH was measured before, and 3, 7, 11, 15, 19, 23 and 27 minutes after, rinsing the mouth with each of the formulas. pH curves were compiled and acidogenicity expressed as 'pH area', minimum pH reached, and maximum pH decrease. No statistically significant differences were observed between the acidogenicity of the soya infant formula and the infant milk.

Adult↗

Lead content in Spanish market infant formulas and toxicological contribution.

Lead content was investigated in infant formulas by using graphite furnace atomic absorption spectroscopy (GFAAS). Formulas were distinguished as 'beginner', 'continuation' and 'special infant formula', the latter being classified as subtypes 'hypoallergenic', 'without lactose', 'vegetable base' and 'others'. The mean concentrations of lead were 25.7+/-8.4, 36.9+/-6.4 and 43.5+/-16.3 microg kg(-1) for beginner, continuation and special infant formula, respectively. Two-factor (types and subtypes) variance analyses were made and Tukey's mean homogeneity test (p < 0.05) was also performed for the formation of homogeneous groups. Significant differences (p < 0.001) were observed between types and two homogeneous groups were formed by the special infant formula type, with the highest lead content; the other group was constituted by the beginner type; and included in both groups were the continuation type infant formula. Their contribution to the provisional weekly intake (PTWI) was calculated from the mean concentrations in each type of infant formula, showing them to be food with a low toxicological risk (< 30% PTWI).

Food Contamination↗

[Protein quality and quantity in infant formulas. A critical look].

The ideal quantity and quality of dietary proteins in milk formulas employed for infant nutrition is still a matter of controversy and debate. During the last years, there has been a tendency to lower the protein content in response to new estimations of protein requirements based on protein intakes and growth rates of breastfed infants. In most infant formulas the protein content is in the range of 1.4-1.8 g/100 ml. The lower limit of this range appears to be adequate for the growth and metabolic needs of the healthy infant. The safety of a further reduction of this limit to 1.2 g/100 ml (~1.8 g/100 kcal), which has been recently proposed, needs additional scrutiny and observation. In addition, the real benefits of this choice have still to be proven. Adjustments for protein digestibility and quality have recently been introduced. The removal from the whey protein fraction of the glycomacropeptide (GMP), with a consequent reduction of excessive threonine intakes, is a novel approach and a further step in the development of infant formulas closer to the model of hu-man milk.

Food, Formulated↗

The protective effect of breast feeding in relation to sudden infant death syndrome (SIDS): II. The effect of human milk and infant formula preparations on binding of Clostridium perfringens to epithelial cells.

Breast feeding is known to protect an infant against gastrointestinal pathogens and epidemiological studies indicate that compared to breast fed infants, formula fed infants are at a greater risk of dying from sudden infant death syndrome (SIDS). Many SIDS infants have symptoms of gastrointestinal infections prior to death and one gastrointestinal pathogen associated with SIDS is Clostridium perfringens. Studies have found that a significantly higher number of formula fed SIDS infants have C perfringens and its enterotoxin in their faeces compared to breast fed infants. The aim of the study was to compare the effects of human milk and infant formula on binding of C perfringens to epithelial cells. Two protocols were used to assess the effect of human milk and infant formula to inhibit binding of C perfringens to epithelial cells. Binding was assessed by flow cytometry. For the in vivo protocol which more closely represents interactions on the mucosal surface, breast milk enhanced bacterial binding but infant formula caused inhibition of binding; however for the in vitro method, both human milk and infant formula resulted in consistent enhancement of binding. Flow cytometry studies indicated that enhancement of binding was due to the formation of bacterial aggregates. Lewis(a) and Lewis(b) antigens, found in both breast milk and infant formula, inhibited C. perfringens binding in a dose dependent manner. The Lewis(a) and Lewis(b) antigens in human milk and infant formula can inhibit C. perfringens binding to epithelial cells. While infant formula reduced binding of C. perfringens to epithelial cells in the experiments carried out with the in vivo protocol, the protective effects of breast feeding in relation to colonisation with C. perfringens are more likely to be due to formation of bacterial aggregates. These findings have implications for improving infant formula preparations.

Animals↗

Mineral retention in three-week-old piglets fed goat and cow milk infant formulas.

Goat milk and cow milk are commonly used in infant formula preparations and, as such, understanding the nutritional characteristics of infant formulas made from these milks is important. In this study, a goat milk infant formula was compared with an adapted (whey-enhanced) cow milk infant formula with respect to mineral absorption and deposition using the 3-wk-old piglet as a model for the 3-mo-old infant. Equal numbers of piglets (n = 8) were fed either the goat milk formula or the cow milk formula. The mineral composition of the prepared goat milk formula was higher than that of the prepared cow milk formula for most minerals, including calcium (75.1 vs. 56.7 mg/100 mL) but excluding iron, which was higher in the prepared cow milk formula (0.92 vs. 0.74 mg/100 mL). The amounts of calcium, phosphorus, and manganese absorbed by the piglets were significantly higher for the goat milk formula, whereas the amounts of zinc, iron, and magnesium absorbed were significantly higher for the cow milk formula. Apparent mineral absorption, relative to intake, was statistically higher in the cow milk formula for calcium and phosphorus, although the actual differences were very small (less than 1.3%). For copper, zinc, iron, and magnesium there was no significant difference between treatments in apparent mineral absorption, whereas for manganese, absorption was higher for the goat milk infant formula. The absolute mineral deposition was higher in piglets fed the goat milk formula for calcium, phosphorus, and manganese, whereas iron deposition was higher in the piglets fed cow milk formula. For all other minerals tested, there were no significant differences between treatments. The goat milk infant formula provided a pattern of mineral retention in the 3-wk-old piglet very similar to that of the adapted cow milk infant formula. The minor differences observed between the 2 appeared to be due to the different mineral contents of the 2 formulas.

Absorption↗

Vitamin E status in preterm infants fed human milk or infant formula.

Vitamin E status was assessed in 36 infants with birth weights less than 1500 gm who were assigned randomly to receive one of three sources of nutrition: milk obtained from mothers of preterm infants (preterm milk), mature human milk, or infant formula. Infants in each dietary group were further assigned randomly to receive iron supplementation (2 mg/kg/day) beginning at 2 weeks or to receive no iron supplementation. All infants received a standard multivitamin, providing 4.1 mg alpha-tocopherol daily. Serum vitamin E concentrations at 6 weeks were significantly related both to type of milk (P less than 0.0001) and to iron supplementation (P less than 0.05). Infants fed preterm milk had significantly higher serum vitamin E levels than did infants fed mature human milk, and both groups had significantly higher levels than did those fed formula. Ratios of serum vitamin E/total lipid were also significantly greater for infants fed human milks than for those fed formula. The addition of iron to all three diets resulted in significantly lower serum vitamin E levels at 6 weeks (P less than 0.05); however, only in the group fed formula was there evidence of vitamin E deficiency. Preterm milk with routine multivitamin supplementation uniformly resulted in vitamin E sufficiency in VLBW infants whether or not iron was administered.

Dietary Fats↗

Selenium content of Spanish infant formulae and human milk: influence of protein matrix, interactions with other trace elements and estimation of dietary intake by infants.

The selenium content of infant formulae varies as a result of differences in the amount of intrinsic selenium compounds. Manufacturers have been gradually changing the protein profile of infant formulae to reflect human milk contents more closely. Because of these variations in infant formula composition and their potential impact on selenium content, this trace element was analysed with regard to the different protein sources. The aims of this study were to determine the selenium content in infant formulae sold commercially in Spain, to estimate a daily dietary intake for infants fed on formulae and to compare with the selenium provided by Spanish breast milk samples used as a reference. We have also identified certain trace elements added to formulae which interact with selenium according to the type and protein matrix of the infant formulae. Selenium concentration was determined by inductively coupled plasma atomic emission spectrometry (ICP-AES) with a hydride generator. The selenium concentrations in human milk and infant formulae determined in this study are similar to those found by other researchers in different countries. The daily selenium intake from the formulae studied was estimated according to the recommended doses from the manufacturers. The theoretical selenium intake of nursed infants has been studied in relation to the Recommended Dietary Allowance (RDA: 10 microg Se/day) and the specific recommendations for infant formula nutrient contents (10-35 microg Se/L) set by the Expert Panel of life Sciences Research Office (LSRO) of the American Society for Nutritional Sciences. According to our results, on an overall view, infants fed on the studied infant formulae have an intake between basal and normative requirements. This might be considered as providing an adequate selenium supply. However, the intake of setenium provided by several formulae included in this research did not reach the RDA for the first month of neonate life.

Animals↗

Microwave heating of infant formula: a dilemma resolved.

Microwave heating of infant formula is a common practice despite concerns of infant scalding. Beyond the issue of physical safety, little is known about the effects on nutrient content of microwave heating of infant formula. Casein-predominant infant formula in 120- and 240-mL glass and plastic nursing bottles of varying colors were heated for 40 seconds and 60 seconds, respectively. Temperature profiling was monitored during the heating cycle. Analysis of riboflavin and vitamin C was made prior to and after heating. Topmost portions reached a mean temperature of 44.7 +/- 1.7 degrees C and 43.0 +/- 2.4 degrees C for all types of 240-mL and 120-mL bottles, respectively. Topmost temperatures were significantly hotter than temperatures reached at other sites. Routine mixing resulted in formula temperatures which could safely be fed to infants (35.4 +/- 0.3 degrees C and 33.9 +/- 0.2 degrees C for 240-mL and 120-mL bottles, respectively). There was no significant loss of either riboflavin or vitamin C. Protocols for microwave heating are given.

Animals↗

Supplementation of infant formula with long-chain polyunsaturated fatty acids does not influence the growth of term infants.

BACKGROUND: Adequate growth is an important indicator of health and well-being in infants. OBJECTIVE: Our objective was to determine the effect of supplementing infant formula with long-chain polyunsaturated fatty acids (LCPUFAs) on the growth of term infants. DESIGN: Using the methodology outlined by the Cochrane Collaboration, we reviewed all known randomized controlled trials that involved LCPUFA supplementation of infant formula fed to term infants. Outcome measures were weight, length, and head circumference. Original data obtained from the investigators of published trials were used. Outcomes were analyzed with fixed-effects or random-effects model meta-analyses and were reported as weighted mean differences with 95% CIs. RESULTS: We identified 14 eligible trials that had data available for meta-analysis (1846 infants). Trial quality was generally high. Meta-analysis showed no significant effect of LCPUFA supplementation on infant weight, length, or head circumference at any assessment age. Similarly, subgroup analyses showed that supplementation with only n-3 LCPUFAs (no arachidonic acid) had no significant effect on infant weight, length, or head circumference. The source of LCPUFA supplementation (phospholipid or triacylglycerol) also did not significantly affect infant growth. CONCLUSION: We found no evidence that LCPUFA supplementation of infant formula influences the growth of term infants in either a positive or a negative way.

Fatty Acids, Unsaturated↗

Soy infant formula and phytoestrogens.

Soy infant formula contains high levels of the isoflavones, genistein and daidzein, which are commonly referred to as phytoestrogens. These are non-steroidal chemicals with structural similarities to estrogen. Infants consuming soy formula have high levels of circulating isoflavones. These are an order of magnitude greater than the levels of isoflavones which have been shown to produce physiological effects in adult women consuming a high soy diet. There is conflicting evidence about the risks and benefits of soy phytoestrogens, with research presenting a contradictory picture. Some reviewers suggest that early exposure to soy may prevent cancer and heart disease. However, there is very little research on the effects of consumption of soy phytoestrogens by human neonates. Against this generally positive view there is an increasing number of recent reports that suggest that in experimental animals, phytoestrogens have adverse effects with respect to carcinogenesis, reproductive function, immune function, and thyroid disease. Despite the absence of adequate scientific research that quantifies the level of risk to infants, most would argue for a precautionary approach to be taken in situations where there are potential developmental effects from the consumption of pharmacologically active compounds in infancy and childhood.

Endocrine Glands↗

Calcium and phosphorus supplementation of iron-fortified infant formula: no effect on iron status of healthy full-term infants.

One objective of this clinical trial was to determine whether calcium and phosphorus supplementation of infant formula affects the iron status of healthy full-term infants. One hundred three infants were randomly assigned to receive iron-fortified, cow milk-based infant formula (465 mg Ca and 317 mg P/L) or the same formula with added calcium glycerophosphate (1800 mg Ca and 1390 mg P/L) for 9 mo. Reported calcium intake for supplemented infants was about four times that of control infants, ranging from a mean of 1741 mg/d at baseline to 1563 mg/d at 9 mo. There was no difference by treatment group in mean or median change from baseline of serum ferritin, total-iron-binding capacity, erythrocyte protoporphyrin, or hematocrit at 4 and 9 mo after enrollment. Incidence of iron deficiency was similar for both groups and no infant developed iron deficiency anemia during the trial. This study indicates that the well-documented inhibitory effect of calcium and phosphorus on iron absorption is not clinically important in infants fed iron-fortified infant formula.

Absorption↗

Cadmium content in infant formulas. Toxicological evaluation.

Cadmium content was investigated in infant formulas by using graphite furnace atomic absorption spectroscopy (GFAAS). Formulas were distinguished as "beginner", "continuation" and "special infant formulas", the last ones were classified as subtypes "hypoallergenic", "without lactose", "vegetable base" and "others". The mean concentrations of cadmium were 1.97 +/- 0.84, 1.86 +/- 0.65 and 2.98 +/- 2.59 micrograms/kg for "beginner", "continuation" and "special infant formulas", respectively. Two-factor (types and subtypes) variance analyses were made and Turkey's mean homogeneity test (p < 0.05) was also carried out for the formation of homogeneous groups. Significant differences (p < 0.001) were observed between subtypes and 3 homogeneous groups were formed, one for "hypoallergenic" and "others", another group was constituted by "without lactose" and, finally another group, one with the highest cadmium content, was formed by subtype "vegetable". Their contribution to the provisional weekly intake (PWI) was calculated from the mean concentrations of each type and subtype of infant formulas, showing them to be food with a low toxicological risk.

Cadmium↗

Variation of the ganglioside compositions of human milk, cow's milk and infant formulas.

The ganglioside compositions of human milk, cow's milk and infant formulas were compared. The results showed that there was a drastic change in the ganglioside composition from the colostrum to later human milk, and that both the patterns and contents of gangliosides in human milk, cow's milk and infant formulas differed markedly. In human milk, the total lipid-bound sialic acid level was two times higher than those in cow's milk and infant formulas. The major ganglioside in the later human milk, GM3 (27.7%), was only a minor component in the colostrum, cow's milk and infant formulas (3.3, 2.8 and 0.4-2.6%, respectively). GD3 represented 49.0, 61.0 and 72.4-86.6%, respectively, of the colostrum, cow's milk and infant formulas, compared to 31.8% of the later human milk gangliosides. Another four gangliosides, which were assumed to be c-series gangliosides, were detected in the colostrum and the later human milk. They represented 33-38% of total lipid-bound sialic acid, and were tentatively designated as GX1, GX2, GX3 and GX4, respectively. However, only GX1 and GX2 were observed in cow's milk and infant formulas. The variation of the gangliosides in human and cow's milk, and infant formulas might have some biological significance regarding neonatal brain development, allergies, infant growth and non-immunoglobulin prophylactic activities against some bacterial toxins.

Animals↗

Effects of long-term consumption of a fermented infant formula (with Bifidobacterium breve c50 and Streptococcus thermophilus 065) on acute diarrhea in healthy infants.

OBJECTIVE: To determine whether long-term consumption of a fermented infant formula could influence the incidence of acute diarrhea and its severity in healthy infants. METHOD: Nine hundred seventy-one infants, ranging in age from 4 to 6 months, were included in a randomized, double-blind, placebo-controlled trial during a period of 5 months. They consumed daily either a fermented infant formula (FF) (fermentation with Bifidobacterium breve C50 and Streptococcus thermophilus 065) or a standard infant formula (SF) of the same nutritional composition. EVALUATION CRITERIA: Number and duration of acute diarrhea episodes were evaluated. Severity of the episodes was determined by the number of hospital admissions, incidence of dehydration, number of medical consultations, number of oral rehydration solution prescriptions, and number of formula switches. RESULTS: Growth of the infants and acceptability of the formulas were identical in the two groups. Incidence, duration of diarrhea episodes, and number of hospital admissions did not differ significantly between groups. Episodes were less severe in the FF (fermented formula) group. There were fewer cases of dehydration 2.5%versus 6.1% (P = 0.01), fewer medical consultations (46%v 56.6%, P = 0.003), fewer ORS prescriptions 41.9%v 51.9% (P = 0.003) and fewer switches to other formulas (59.5%v 74.9%, P = 0.0001) in FF infants compared to SF. CONCLUSION: A fermented formula may reduce the severity of acute diarrhea among healthy young infants. This outcome may be linked to the bifidogenic effects of fermentation products and their interactions with the intestinal immune system.

Acute Disease↗