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Effect of timing of introduction of complementary foods on iron and zinc status of formula fed infants at 12, 24, and 36 months of age.

OBJECTIVE: The timing of introduction of complementary food to an infant's diet is variable throughout the world. Our objective was to determine whether early introduction of complementary foods affects iron and zinc status of formulated infants at 12, 24, and 36 months of age. DESIGN: A randomized, prospective trial was conducted. Infants were randomly assigned to receive either a) early introduction (at 3 to 4 months of age) of commercially prepared or parent's choice of complementary foods; or b) late introduction (at 6 months of age) of commercially prepared complementary foods or parent's choice of complementary foods. In addition to complementary foods, infants were fed commercial infant formula as recommended by their pediatrician. Hemoglobin, mean corpuscular volume, and serum ferritin and zinc concentrations were determined at 12, 24, and 36 months of age. Three-day diet diaries were completed at 3, 6, 12, 18, 24, 30, and 36 months of age. SUBJECTS/SETTING: One hundred seventy-five infants younger than 3 months were recruited by mailings to parents in the Cincinnati area. Of these, 172 were enrolled, 90 in the early-introduction group and 82 in the late-introduction group. One hundred thirty-three infants (n = 67 in the early, n = 66 in the late group) completed the study. STATISTICAL ANALYSES PERFORMED: Student t test and regression analyses were used to determine whether there were group differences and whether there was a relationship between serum parameters and dietary intake. RESULTS: Infants fed complementary foods early had significantly greater iron intakes until 6 months of age; however, there were no differences in the iron status parameters (ferritin, hemoglobin, and mean corpuscular volume) at 12, 24, or 36 months of age. The early introduction group consumed slightly less zinc than the late introduction group at 5 months (4.4 vs 4.8 mg/day, P < .01) and 6 months (4.4 vs 4.7 mg/day, P < .01). At all other times there were no differences between the early and late group in zinc intakes. The serum zinc concentration was not associated with dietary zinc. Both groups had normal serum zinc concentrations at 12, 24, and 36 months and there were no differences between groups. APPLICATIONS/CONCLUSIONS: The iron and zinc status of infants in this study was not influenced by the timing or type of complementary foods introduced. However, the infants were formula fed and the mean iron and zinc intakes that were equal or greater than the Recommended Dietary Allowances for the first 6 months of age.

Age Factors↗

Evaluation of the effect of a fiber-enriched formula on infant colic.

Because infants with colic appear to have abdominal pain similar to that of adults with irritable bowel syndrome, who may benefit from the addition of fiber to their diet, we tested whether fiber added to infant formula would alleviate colic. Twenty-seven normal, term infants (aged 2 to 8 weeks; 14 girls) with colic, defined as crying plus fussing for more than 3 hours a day for at least 3 days of a 6-day baseline period, were enrolled. Infants were randomly assigned in 9-day periods to a sequence of placebo (Isomil formula) followed by fiber-supplemented formula (Isomil plus soy polysaccharide) (n = 12) or the reverse (n = 15). Daily diaries of crying, fussing, sleeping, formula, intake, and stooling were kept. Twenty-two infants completed three lactulose breath hydrogen tests at the end of the baseline period and after each study period. The crossover trial was followed by 30 to 35 days of use of the study formula chosen by the parents as most beneficial but unknown to the investigators. Growth was monitored throughout. Serum cholesterol, calcium, phosphate, albumin, iron, and zinc concentrations were measured at the conclusion. There were no significant differences in average daily time spent by the infants in fussing and crying during ingestion of the fiber-supplemented formula. However, parents of 18 of 27 infants chose fiber-supplemented formula as most beneficial in ameliorating symptoms of colic. While the infants were consuming fiber-supplemented formula, stool frequency increased, and breath hydrogen excretion increased significantly, in response to lactulose. Growth and serum biochemical measurements were normal in all infants. Supplementation of infant formula with the level of soy polysaccharide used in this study may have reduced crying and fussing in some infants but did not affect colicky behavior in the majority of infants, who continued to cry and fuss excessively.

Breath Tests↗

Nutrient intakes of formula-fed infants and infants fed cow's milk.

Twenty-four-hour dietary intake data from the second National Health and Nutrition Examination Survey (NHANES II), 1976-1980, were analyzed to compare nutrient intakes among infants 7 to 12 months of age who were fed mixed diets containing solid foods and either infant formula or cow's milk. Solid foods fed to the infants in both groups were low in iron and linoleic acid, and high in sodium, potassium, and protein, relative to Recommended Dietary Allowances. Infants who were fed cow's milk received lower median intakes of iron (7.8 mg v 14.9 mg), linoleic acid (1.8 g v 6.1 g), and vitamin C (39 mg v 64 mg), and higher median intakes of protein (41 g v 25 g), sodium (1,000 mg v 580 mg), and potassium (1,630 mg v 1,020 mg) than formula-fed infants. Seventy-five percent of the infants fed cow's milk had iron intakes below the Recommended Dietary Allowance; 69% had sodium intakes above the range of estimated safe and adequate daily dietary intake. Linoleic acid provided less than 3% of energy intake for 74% of the infants fed cow's milk. Differences in nutrient intakes were due not only to different concentrations of nutrients in each of the milk feedings but also to the different amounts and types of solid foods fed to the two groups of infants.

Animals↗

An assessment of the salient olfactory environment of formula-fed infants.

Olfactory preferences of two-week-old bottle-fed infants were assessed in a series of simultaneous two-choice tests. Infants of each sex displayed preferential orientation to a stimulus pad worn on their mother's breast over a clean control pad. When maternal breast odor was paired with the odor of the infants' formula, however, boys spent more time oriented toward the formula odor, whereas girls evinced no reliable preferences. Although the subject infants had no prior direct contact with odors emanating from the breasts of lactating females, but had recurring reinforced exposure to the odor of their familiar formula (in the context of feeding), the former scents elicited a more positive response. Preferential orientation to lactating-breast odors reflects adaptive inborn attraction to cues associated with the natural food source for human neonates.

Attention↗

[Current views on requirements for vitamin D, calcium and phosphorus, particularly in formula fed infants].

Calcium (Ca) and phosphorus (P) absorption depends on vitamin D. Vitamin deficiency in children results in rickets and osteoporosis in adults. Prematurely born infants are at risk of osteopenia and rickets. Skin synthesis of vitamin D can obtain the level of 10 000 IU (250 ug) when the whole body is exposed to the sun. Recent opinion on vitamin D requirement establishes the level of more than 80 nmol/L of 25(OH)D. There are no recommendations for children but it seems that due to the risk of skin cancer, exposure to the sun in children will be limited and as a result higher dose of vitamin D will be needed. Calcium and phosphorus are the most common minerals of the human body. Calcium concentration in human milk is not related to the intake. Calcium intake of calcium in premature infants is 70-140 mg/100 kcal. Phosphorus content in breast milk, even as low as 15 mg%, can maintain the optimal Ca/P ratio of 2/1. Prolonged breast feeding without additional Ca and P, may result in reduced bone mineralisation. Higher content of calcium in infant formula in comparison to human milk is due to the fact that Ca absorption from breast milk is 60% in comparison to 40% absorption from the formula.

Absorption↗

Bovine beta-lactoglobulin levels in hydrolysed protein formulas for infant feeding.

A bovine milk protein, beta-lactoglobulin (beta LG), was measured by an enzyme-linked immunosorbent assay (ELISA) in seven different infant formulas based on protein hydrolysates from cows' milk whey or casein, and from bovine collagen and soy. beta LG levels in the formulas were 1/100 to 1/4,800,000 lower than in cows' milk (CM). There was a great difference in the beta LG level between the partly and the extensively hydrolysed formulas; the amount of beta LG was 40,000-fold higher in the partial hydrolysates vs the extensively hydrolysed formulas. Residual beta LG may have been responsible for the allergic reactions described in some children with cows' milk allergy (CMA) receiving these formulas.

Animals↗

Phytoestrogens in soy-based infant foods: concentrations, daily intake, and possible biological effects.

Exposure to estrogenic compounds may pose a developmental hazard to infants. Soy products, which contain the phytoestrogens, genistein and daidzein, are becoming increasingly popular as infant foods. To begin to evaluate the potential of the phytoestrogens in these products to affect infants, we measured total genistein and daidzein contents of commercially available soy-based infant formulas, infant cereals, dinners, and rusks. We also assayed phytoestrogens in dairy-based formulas and in breast milk from omnivorous or vegetarian mothers. In most cases, the glucoside forms of the phytoestrogens were hydrolyzed before separation by HPLC. Mean (+/-SEM) total genistein and daidzein contents in four soy infant formulas were 87+/-3 and 49+/-2 microg/g, respectively. The phytoestrogen content of cereals varied with brand, with genistein ranging from 3-287 microg/g and daidzein from 2-276 microg/g. By contrast, no phytoestrogens were detected in dairy-based infant formulas or in human breast milk, irrespective of the mother's diet (detection limit = 0.05 microg/ml). When fed according to the manufacturer's instruction, soy formulas provide the infant with a daily dose rate of total isoflavones (i.e., genistein + daidzein) of approximately 3 mg/kg body weight, which is maintained at a fairly constant level between 0-4 months of age. Supplementing the diet of 4-month-old infants with a single daily serving of cereal can increase their isoflavone intake by over 25%, depending on the brand chosen. This rate of isoflavone intake is much greater than that shown in adult humans to alter reproductive hormones. Since the available evidence suggests that infants can digest and absorb dietary phytoestrogens in active forms and since neonates are generally more susceptible than adults to perturbations of the sex steroid milieu, we suggest that it would be highly desirable to study the effects of soy isoflavones on steroid-dependent developmental processes in human babies.

Child Development↗

Randomized, double-blind comparison of growth in infants receiving goat milk formula versus cow milk infant formula.

OBJECTIVE: To compare growth of infants fed goat milk infant formula (GMF) or cow milk infant formula (CMF) and to compare tolerability and safety of the two formulas. METHODS: The study was conducted in Auckland, New Zealand. This was a double-blind randomized controlled trial. Newborn term infants were randomized within 72 h of birth to GMF or CMF. Milk formula powder in single serve sachets were reconstituted and fed to infants from trial commencement until age 168 days. No other formula given from randomization until age 168 days. Infant weight, length and head circumference were measured at birth and age 14, 28, 56, 84, 112, 140 and 168 days. Bowel motion frequency and consistency, sleeping and crying patterns and adverse events were also measured. RESULTS: Seventy-two infants were randomized, 36 each to GMF or CMF, with 62 infants completing the intervention. At enrollment the average weight of infants in the GMF group (mean +/- SD) was 3.33 +/- 0.43 kg and in the CMF group 3.43 +/- 0.47 kg; and at study completion 8.07 +/- 0.90 kg (GMF) and 7.87 +/- 0.99 kg (CMF). The difference in average weight gain over the study period for the GMF group versus the CMF group was not significant (+309 g; 95% CI = -49 to +668, P = 0.09). Median daily bowel motion frequency was greater in the GMF group than the CMF group (2.4 vs 1.7, P = 0.01). There were no group differences in bowel motion consistency, duration of crying, ease of settling, or frequency of adverse events. CONCLUSION: Growth of infants fed GMF is not different to that of infants-fed CMF.

Animals↗

CoQ10 plasmatic levels in breast-fed infants compared to formula-fed infants.

BACKGROUND: Coenzyme Q10 has been recognized as an important antioxidant factor besides its main role in bioenergetic metabolism. CoQ10 tissue levels depend both on exogenous dietetic intake and on endogenous biosynthesis, as this compound can be partly synthesized in human cells. Q10 plasma levels reflect the tissue content of the coenzyme and can be used to evaluate the presence of this compound in the human organism. DESIGN/METHODS: Aim of the study was to measure CoQ10 plasmatic levels in a newborn breast-fed population and to compare them to CoQ10 levels in a newborn formula-fed population in order to verify whether changes in CoQ10 plasmatic contents could be related to a different dietetic intakes. We measured CoQ10 plasmatic levels in 25 healthy term neonates with different dietetic intakes: 15 breast-fed and 10 bottle-fed with a common infant formula. These infants were evaluated prospectively during the first month of life. The analyses were performed on the mothers' blood samples and cord blood samples at the time of delivery, then on infants at 4 and 28 days of age. RESULTS: Our results showed markedly reduced Q10 levels in cord blood samples compared to maternal Q10 plasmatic levels at the time of delivery, suggesting placental impermeability towards this molecule or increased fetal utilization during labor and delivery. At 4 days of age Q10 levels had increased in both groups of neonates, but significantly more in breast-fed infants compared to formula-fed babies (p <0.05). At 4 weeks of age no significant changes occurred in breast-fed infants, while values increased significantly in formula-fed infants (p <0.05). The content of Q10 in breast milk samples was lower than in infant formula. CONCLUSIONS: The results of this study show that CoQ10 plasmatic levels are at least partly influenced by the exogenous dietetic supply.

Aging↗

[The evaluation of gastrointestinal tolerance for a new infant feeding formula (Similac) in healthy infants].

There is a pediatric consensus that maternal milk is the best food for the new born, but when this is impossible, one turns to artificial nutrition. The main objective of infant formulae is to achieve a gastrointestinal tolerance that is similar to maternal milk. With this in mind, we carried out an observational, prospective, and multicentric study with the objective of evaluating the gastrointestinal tolerance of Similac, taking maternal milk and other formulae on the market as reference. The study included 2 pediatric visits, a diary in which the parents recorded the gastrointestinal parameters, and a final questionnaire to evaluate the degree of satisfaction. Information was obtained from 6,617 evaluable cases, 82.2% fed with Similac (S), 8.8% with maternal milk (MM) and 9% with other formulae (OF). The analysis of the data showed that the percentage of children with signs of gastrointestinal intolerance, was reduced to more than half when using S compared to OF (5.6% S, 5% LM, and 14.1% OF). The color and consistency of the feces was significantly associated with the formula group, and in both cases S showed a greater similarity to the pattern obtained with MM compared to the OF group. 18.6% of the children with OF presented hard feces, and this percentage was reduced to at least half with S (6.2%). The S group showed a greater percentage of lack of regurgitations and no aerophagia and the lowest percentage for three or more regurgitations and severe aerophagia. Those questioned considered that S was easier to reconstitute up, is liked better, and is better tolerated than the OF used. Similac achieved a greater similarity in gastrointestinal tolerance to that of maternal milk than other formulae did.

Breast Feeding↗

15N-tracer studies in formula-fed preterm infants: the role of glycine supply in protein turnover.

In preterm infants, protein-turnover rates obtained by [15N]glycine as a tracer are known to be overestimated. This may reflect the insufficient supply of dietary glycine. In this randomized study, the influence of a glycine-rich diet on whole body protein turnover rates in eight male preterm infants (29-32 weeks, 1,200-2,540 g birthweight) using the 15N-tracer technique on days 21 and 28 of life was investigated to evaluate the necessity of supplementing preterm infant formulas with proteins rich in glycine. Before and during the study, the infants were alternately fed with a commercial available preterm infant formula (I, 2% protein, 40 mg glycine/dl) and a variety of this formulation with glycine-rich proteins (II, 2% protein, 130 mg glycine/dl). The protein-turnover rates were computed after 15N-single-pulse labeling with the help of the three-compartment model (TCM) and the urinary ammonia end-product method (AEPM). The tracer used was [15N]glycine (dosage: 2 mg 15N/kg). For the determination of 15N-excess-excretion kinetics, fractionated urine specimens were collected over a 36-h period. The protein-turnover rate calculated by TCM was 8.8 +/- 1.6 g/kg/day (formula I) and 7.7 +/- 2.0 g/kg/day (formula II); using AEPM, the rate was 8.7 +/- 2.5 g/kg/day and 7.5 +/- 1.5 g/kg/day, respectively. We conclude that the presaturation of the precursor pool by an adequate glycine intake minimizes drawbacks that may arise when using [15N]-glycine as a tracer in preterm infants, and a protein concentration of 2%, as in formula I, and consequently, a 170% glycine content when compared with the same human milk volume, meets the glycine requirement.

Birth Weight↗

Serum myoinositol concentrations in premature infants fed human milk, formula for infants, and parenteral nutrition.

Myoinositol concentration was studied in serum of 65 neonates and their mothers at the time of birth, in samples of various types of feedings for infants, and in serial serum samples of 15 premature infants receiving human milk, formulas for infants, or parenteral nutrition over a 3-wk period. At birth the serum concentration of myoinositol was greater in neonates than in their mothers (108 +/- 10 vs 52 +/- 6 mumol/L, respectively, means +/- SEM, p less than 0.01). In feedings for infants, the concentrations of myoinositol were significantly greater in human milk than in formulas or parenteral nutrition solutions (1840 +/- 451 vs 420 +/- 110 vs 100 +/- 8 mumol/L, respectively, p less than 0.001). Over a 3-wk period the serum concentration of myoinositol increased in infants receiving human milk but not in those receiving formulas or parenteral nutrition. Serum concentrations of myoinositol in neonates are greater than in adults and are directly influenced by myoinositol intake.

Adult↗

Protein quality and quantity in cow's milk-based formula for healthy term infants: past, present and future.

The development of infant formula with optimized protein quality and quantity has been, and still is, the subject of intense investigation. A better understanding of the protein composition of breast milk and infant needs in association with technological breakthroughs in cow's milk fractionation, has led to the development of infant formulas with a protein content that is closer to that of human milk. Today, infant formulas with a protein/energy ratio of 1.8 g/100 kcal are commercially available. These formulas have been shown to be safe and nutritionally adequate for term infants. However, the short-term and potentially long-term metabolic benefits of formulas with reduced protein content have still to be elucidated and are currently under investigation. In addition to providing amino acids as building blocks for growth, milk is the source of numerous bioactive factors/hormones which are involved in multiple physiological processes. Continuous efforts are being made to identify new bioactive compounds in human milk. However, a better understanding of their biological functions in suckling infants as well as a comparison with their bovine counterparts are needed. Technological processes, which preserve some bioactive factors in cow's milk already exist. These processes could be applied to infant formulas.

Animals↗

Lymphocyte subpopulations in breast-fed and formula-fed infants at six months of age.

UNLABELLED: Factors such as cytokines and lymphocytes present in human milk can influence the developing immune system. This suggests an immunoregulatory role for human milk that is absent in infants consuming formula. There are very few data available from well-defined groups of breast-fed and formula-fed infants with regard to their immune status as reflected by lymphocyte immunophenotypic values. The aim of this study was to investigate the potential difference in lymphocyte subsets between breast-fed and formula-fed infants at 6 months of age. Blood samples were taken by venipuncture. Lymphocytes were analyzed by 2-color direct immunofluorescence with Becton Dickinson Immunocytometry Systems SimulSET reagents (BD, Franklin Lakes NJ). There were 73 breast-fed infants and 55 formula-fed infants at 6 months of age. The frequency of natural killer (NK) cells (CD3-/CD16+ + CD56+) was greater in breast-fed infants (9.2%) than in formula-fed infants (6.6%, P < 0.001), while the CD4 to CD8 ratio was 2.8 in breast-fed infants compared with 3.4 in formula-fed infants (P < 0.001). CONCLUSION: Breast-fed infants (<250mL formula/bovine milk per week) had a greater proportion of NK cells and a lower CD4 to CD8 ratio than formula-fed infants at 6 months of age.

Antigens, CD19↗

Effect of two types of fish oil supplementation on plasma and erythrocyte phospholipids in formula-fed term infants.

We studied the effect of docosahexaenoic acid (DHA) supplementation of infant formulas on fatty acid composition of blood phospholipids in term infants. Two fish oil supplemented formulas containing 0.45 wt% DHA and high (0.35%) or low (0.10%) eicosapentaenoic acid (EPA) were fed for 42 days and compared with a standard formula and breast milk. Infants fed supplemented formulas and breast milk had similar time-dependent changes for DHA from birth to day 42, i.e., slight decreases in plasma phospholipids and erythrocyte phosphatidylcholine and no change in erythrocyte phosphatidylethanolamine. Low-EPA formula prevented EPA accumulation but did not limit the significant decrease in arachidonic acid (AA) noted in infants fed high-EPA formula. These results suggest that term infant formulas should be supplemented with DHA-rich EPA, low fish oil and AA to achieve a fatty acid status in formula-fed infants similar to that of breast-fed infants.

Arachidonic Acid↗

Energy expenditure in human milk- versus formula-fed preterm infants.

OBJECTIVE: We compared energy expenditure (EE) of preterm infants fed their mother's milk versus preterm infant formula. Study design A prospective, randomized crossover study of 13 healthy, appropriate weight for gestational age, gavage-fed, preterm infants. Before the study and according to our feeding protocol, infants uniformly received alternate feeds of human milk and formula. Each infant was randomly assigned to 24 hours of formula feeding followed by 24 hours of breast milk or the reverse. Infants were studied asleep, at the end of each 24-hour period. EE was measured by indirect calorimetry 1 hour before feeding, 20 minutes during feeding, and 1 hour after feeding in a servo-controlled convective incubator. Energy content of human milk was analyzed by bomb calorimetry. RESULTS: EE was significantly lower in breast milk-fed infants during prefeeding (52+/-6 vs 57+/-10 kcal/kg per 24 hours) (P<.05), per feeding (55+/-6 vs 60+/-10 kcal/kg per 24 hours) (P<.05), and at the postfeeding measurement (60+/-7 vs 65+/-7 kcal/kg per 24 hours) (P=.059). After correction of the results for the actual measured energy intake, all statistical differences reached the <.05 level. CONCLUSIONS: Preterm infants have lower EE when they are fed breast milk than when they are fed preterm infant formula.

Calorimetry, Indirect↗

Serum hemolytic and bactericidal activity in breast and formula-fed infants.

Whether formula or breast feeding influences the functional activity of the complement system from birth to three months of age has been studied. The classical pathway was evaluated by assessing hemolytic activity, based on the capacity of the intact complement system to lyse sheep erythrocytes when coated with specific antibodies. The bactericidal activity of the serum against Staphylococcus aureus and Escherichia coli was used to evaluate the alternative complement pathway. Sera were obtained from neonates (40 +/- 2 weeks of gestation), and one-month or three-month old infants, fed either breast or formula. Control serum was obtained from healthy adults between 22 and 30 years of age. The hemolytic capacity of serum from breast-fed infants of one month and three months of age was significantly greater than that of the serum from infants which had been fed formula milk.

Breast Feeding↗

Effects of feeding regimen on blood glucose levels and plasma concentrations of pancreatic hormones and gut regulatory peptides at 9 months of age: comparison between infants fed with milk formula and infants exclusively breast-fed from birth.

Little is known about the development of gut endocrine responses to food intake in infants after the first postnatal month. To examine this question and to ascertain whether the mode of feeding from birth affects postprandial endocrine changes, blood glucose levels and the plasma concentrations of 11 regulatory peptides were measured at 9 months of age before and after a breast feeding in 13 exclusively breast-fed infants and before and after a formula feeding in 7 infants weaned during the first 3 months of life. In the prefeeding concentrations of these substances, no significant differences were found between the two groups, with the possible exception of the plasma concentration of pancreatic polypeptide (p = 0.06). Postprandially, the responses were significantly smaller in the breast-fed infants, whose plasma concentrations of insulin, gastric inhibitory polypeptide, pancreatic polypeptide, and cholecystokinin were lower than in the formula-fed infants. In addition, the overall level of the insulin-glucagon ratio was lower (p = 0.03) in the breast-fed infants. A difference in the opposite direction was observed for plasma gastrin levels. No significant differences appeared between the groups for blood glucose, or plasma glucagon, vasoactive intestinal polypeptide, motilin, enteroglucagon, secretin, or neurotensin concentrations after feeding. It is concluded that at 9 months of age, the gut regulatory responses to milk feeding are of lower magnitude than during the neonatal period, but even at this age the response patterns still depend on the mode of feeding.

Animals↗