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PubMed1998

Special formulas in infant nutrition: a review.

Special formulas should only be used by medical prescription and for those lactating infants with diagnosed nutritional problems. Lactose-free formulas or those based on soy are the logical choice when the exclusion of lactose from the diet is considered necessary. At present, there is no concensus on the appropriateness of soy formulas for the treatment and prevention of nutritional allergies and current opinion seems to favour hydrolyzed protein formulas. High-degree protein hydrolysate formulas are used to treat lactating infants with an allergy to cow milk proteins or with serious nutritional problems. These formulas are not without risk, as they may contain residual epitopes capable of provoking a severe allergic reaction. Before using these formulas, allergenicity tests should be performed, particularly for highly sensitive infants. The unpleasant taste and high cost of these formulas, in addition to possible nutritional problems, limit their use in the prevention of atopic disease, although their efficacy is well established. Partially protein hydrolysate formulas are only used for preventive purposes and are not suitable for lactating infants with a proven allergy to cow milk. Although these formulas can reduce the incidence or delay the appearance of certain atopic symptoms, they have not been shown to prevent IgE-mediated allergic reactions to cow's milk and so their effectiveness is open to question.

Dietary Proteins↗
PubMed2006

Potential of selected infant food formulas for production of Bacillus cereus emetic toxin, cereulide.

Cereulide producing Bacillus cereus was isolated from randomly chosen commercial infant foods. The cereulide production in infant food formulas was investigated. When the reconstituted foods were inoculated with >10(5) cfu ml(-1) of cereulide producing B. cereus, 2 to 200 microg of cereulide per 100 ml of food accumulated during 24 h of non-refrigerated storage. The amount of cereulide measured in the foods by the accurate chemical assay (LC-MS) matched with that found by sperm micro assay, proving the cereulide was the sole heat stable toxin in the foods and present in its toxic form. The infant formulas containing both cereal and dairy ingredients were the most supportive for cereulide production. Cereulide accumulation was affected by the infant food composition as well as by the handling of the food. Diluting the reconstituted food with water resulted in increased toxin production expressed as mug per volume. More cereulide was accumulated when the food was incubated stationary compared with moderate shaking. The amount of cereulide accumulated within 24 h at room temperature per 100 ml of cereal and dairy or in rice-nondairy reconstituted infant formulas, inoculated with >or=10(5) cfu ml(-1) of B. cereus strain F4810/72, was higher or similar to the amounts reported for foods implicated in emetic type of food poisonings. Thus mishandling and temperature abuse of infant foods may cause food poisoning when emetic B. cereus is present.

Bacillus cereus↗
PubMed2005

Choline status in newborns, infants, children, breast-feeding women, breast-fed infants and human breast milk.

This study assessed the choline status in newborns, infants, children, breast-feeding women, breast milk, infant formula, breast-fed and formula-fed infants. The serum free choline level was 35.1+/-1.1 micromol/L at birth and decreased to 24.2+/-1.6, 18.1+/-0.8, 16.3+/-0.9, 14.3+/-0.8, 12.9+/-0.6 or 10.9+/-0.6 micromol/L at 22-28, 151-180, 331-365, 571-730, 731-1095 or 4016-4380 days after birth, respectively. The serum phospholipid-bound choline level was 1997+/-75 micromol/L at birth and increased gradually to 2315+/-190 or 2572 +/-100 micromol/L at 571-730 or 4016-4380 days after birth, respectively. In breast-feeding women, serum free and phospholipid-bound choline levels were doubled at 12-28 days after birth, they decreased toward the control values with time. Free choline, phosphocholine and glycerophosphocholine were major choline compounds in breast milk. Their concentrations in mature milk were much greater than in colostrum and serum. Choline contents of breast milk varied greatly between mothers, and milk free choline levels were correlated with serum free choline (r=.541; P<.001), phospholipid-bound choline (r=.527; P<.001) and glycerophosphocholine (r=.299; P<.01) concentrations and lactating days (r=.520; P<.001). In breast-fed infants, serum free choline concentrations were correlated with free choline (r=.47; P<.001), phosphocholine (r=.345; P<.002), glycerophosphocholine (r=.311; P<.01) and total choline (r=.306; P<.01) contents of breast milk. Serum free choline concentration in formula-fed infants was lower than breast-fed infants. These data show that (a) circulating choline status is elevated during infancy and lactation, (b) choline contents of breast milk vary between mothers and milk free choline contents are influenced by maternal circulating choline status, and (c) the choline contents of breast milk can influence infants' circulating choline status.

Adult↗
PubMed1989

Intrinsic and extrinsic stable isotopic zinc absorption by infants from formulas.

The kinetics of fecal elimination and the extent of fractional absorption of intrinsic and extrinsic zinc from infant formula were studied in 11 human infants by using a direct, simultaneous dual-label method based on fecal monitoring of unabsorbed stable isotope labels. The relative positions of the two stable isotopic tags (67Zn, 70Zn) as extrinsic and intrinsic labels were reversed in two separate determinations of fractional absorption. Administration of doubly labeled formula for 24 h or less permitted elimination of unabsorbed labels before the end of a 72-h metabolic interval. The extent of enrichment and the kinetics of fecal elimination of unabsorbed extrinsic stable isotopic zinc tag were observed to agree closely with the corresponding values for the intrinsic tag. Fractional absorption of intrinsic and extrinsic tags was highly correlated and did not differ significantly. The ratio of fractional absorption of extrinsic tag to that of intrinsic tag was 1.05 +/- 0.19 (mean +/- SD). The results constitute strong support for validation of the use of enriched stable isotopes at low levels (less than or equal to 10%) of extrinsic addition to milk-based diets for studies of zinc absorption by humans.

Analysis of Variance↗
PubMed1997

Aflatoxin: is it a neglected threat for formula-fed infants?

In the present study, the risk of exposure to aflatoxin in infants fed breast milk and formula was investigated. For this purpose, aflatoxin B1 (AFB1) was determined in the serum of both breast-fed and formula-fed infants. Serum AFB1 positivity was significantly higher in the formula-feeding (F) group than the breast-feeding (B) group (42.8 vs 8.5%, P < 0.01). The AFB1 concentration in different commercial formulas was also determined. Aflatoxin B1 was found in seven of the eight newly opened packages of different brands of formula. The concentrations showed a statistically significant increase at the 30th day after opening the packages (P < 0.01). Although AFB1 concentrations in the formulas were found to be within acceptable limits for most countries, still, its existence must be carefully evaluated because future influences of very small amounts of aflatoxin on the growing organism have not been fully elucidated. Therefore, it was again concluded that for infants, human milk is safer than commercial formulas because of the lower contamination risk of aflatoxin. Also, commercial formulas must be regularly examined by authorities for the possible risk of aflatoxin contamination.

Aflatoxin B1↗
PubMed2006

Detection of Enterobacter sakazakii in dried infant milk formula by cationic-magnetic-bead capture.

Enterobacter sakazakii has been associated with life-threatening infections in premature low-birth-weight infants. Contaminated infant milk formula (IMF) has been implicated in cases of E. sakazakii meningitis. Quick and sensitive methods to detect low-level contamination sporadically present in IMF preparations would positively contribute towards risk reduction across the infant formula food chain. Here we report on the development of a simple method, combining charged separation and growth on selective agar, to detect E. sakazakii in IMF. This protocol can reliably detect 1 to 5 CFU of E. sakazakii in 500 g of IMF in less than 24 h.

Bacteriological Techniques↗
PubMed2000

Breast-fed infants achieve a higher rate of brain and whole body docosahexaenoate accumulation than formula-fed infants not consuming dietary docosahexaenoate.

Docosahexaenoate (DHA) has been increasingly recognized as an important fatty acid for neural and visual development during the first 6 mon of life. One important point of controversy that remains is the degree to which adequate levels of DHA can be acquired from endogenous synthesis in infants vs. what should be provided as dietary DHA. We have approached this problem by a retrospective analysis of published body composition data to estimate the actual accumulation of DHA in the human infant brain, liver, adipose tissue, remaining lean tissue, and whole body. Estimating whether infants can synthesize sufficient DHA required comparison to and extrapolation from animal data. Over the first 6 mon of life, DHA accumulates at about 10 mg/d in the whole body of breast-fed infants, with 48% of that amount appearing in the brain. To achieve that rate of accumulation, breast-fed infants need to consume a minimum of 20 mg DHA/d. Virtually all breast milk provides a DHA intake of at least 60 mg/d. Despite a store of about 1,050 mg of DHA in body fat at term birth and an intake of about 390 mg/d alpha-linolenate (alpha-LnA), the brain of formula-fed infants not consuming DHA accumulates half the DHA of the brain of breast-fed infants while the rest of the body actually loses DHA over the first 6 mon of life. No experimental data indicate that formula-fed infants not consuming DHA are able to convert the necessary 5.2% of alpha-LnA intake to DHA to match the DHA accumulation of breast-fed infants. We conclude that dietary DHA should likely be provided during at least the first 6 mon of life.

Brain↗
PubMed1984

Respiratory and gastrointestinal illnesses in breast- and formula-fed infants.

Ten breast-fed infants, each paired with a formula-fed infant, were evaluated prospectively from birth to the age of 112 days to identify respiratory and gastrointestinal (GI) illnesses and microorganisms associated with respiratory tract infections. The infants were matched by age and sex. More GI illnesses occurred among the formula-fed infants. Although the breast-fed infants had less exposure to tobacco smoke in the home and less exposure to other children in day-care settings, there was no suggestion of a decrease in the frequency of respiratory illness during the first four months.

Bottle Feeding↗
PubMed2003

Brain ganglioside and glycoprotein sialic acid in breastfed compared with formula-fed infants.

BACKGROUND: The concentration of sialic acid in brain gangliosides and glycoproteins has been linked to learning ability in animal studies. Human milk is a rich source of sialic acid-containing oligosaccharides and is a potential source of exogenous sialic acid. OBJECTIVE: The aim of the study was to compare the sialic acid concentration in the brain frontal cortex of breastfed and formula-fed infants. DESIGN: Twenty-five samples of frontal cortex derived from infants who died of sudden infant death syndrome were analyzed. Twelve infants were breastfed, 10 infants were formula-fed, and 1 infant was mixed-fed; the feeding status of the remaining 2 infants was unknown. Ganglioside-bound and protein-bound sialic acid were determined by HPLC. Ganglioside ceramide fatty acids were also analyzed to determine the relation between sialic acid and long-chain polyunsaturated fatty acids. RESULTS: After adjustment for sex with age at death as a covariate, ganglioside-bound and protein-bound sialic acid concentrations were 32% and 22% higher, respectively, in the frontal cortex gray matter of breastfed infants than in that of formula-fed infants (P < 0.01). Protein-bound sialic acid increased with age in both groups (P = 0.02). In breastfed but not in formula-fed infants, ganglioside-bound sialic acid correlated significantly with ganglioside ceramide docosahexaenoic acid and total n-3 fatty acids. CONCLUSIONS: Higher brain ganglioside and glycoprotein sialic acid concentrations in infants fed human milk suggests increased synaptogenesis and differences in neurodevelopment.

Aging↗
PubMed1981

Hematologic and selenium status of low-birth-weight infants fed formulas with and without iron.

Preterm infants with birth weights between 1,001 and 1,600 gm were randomly assigned at one week of age to three groups and fed a standard milk-based formula, the same formula with iron, or a soy-based formula with iron. Hematologic values and selenium status were then studied prospectively for five weeks. Rates of decline in hematocrit and hemoglobin did not differ significantly among the three groups and did not correlate with red cell selenium values or glutathione peroxidase activity. Attainment of vitamin E sufficiency was variable among the infants, with no significant intergroup differences. Plasma selenium concentrations did not change significantly, but plasma glutathione peroxidase activity declined consistently in all three groups. Under the conditions of this study, iron at a concentration of 12 mg/L of infant formula did not accelerate hemolysis; nor was there evidence of a direct association between selenium values and early anemia of prematurity.

Glutathione Peroxidase↗
PubMed1995

Effect of different vitamin A intakes on very-low-birth-weight infants.

Formula-fed infants with birth weights < or = 1500 g (n = 61) were stratified by 250-g birth-weight ranges and randomly assigned to receive one of three preterm infant formulas (vitamin A contents of 820 IU, 1640 IU, or 2900 IU/MJ; 1 RE = 3.3 IU vitamin A activity) when subjects tolerated 0.314 MJ.kg-1.d-1. Experimental formula feedings were continued until infants weighed approximately 2 kg or until hospital discharge. Vitamin A status as indicated by serum retinol and retinol-binding protein (RBP) concentrations significantly decreased during experimental formula feeding at the lowest vitamin A intake. All subjects fed the formula providing the lowest vitamin A intake had hyporetinolemia (< 0.70 mumol/L, or < 20 micrograms/dL), which occurred less frequently (P < 0.05) with the intermediate (6 of 20) and the high (6 of 21) vitamin A intakes. Other outcome measures, including increases in weight, length, and head circumference, and ventilatory support and oxygen therapy, were not different among groups. After the end of the experimental formula-feeding period, all infants were fed standard infant formulas with a vitamin A content of 715 IU/MJ. In a subset of 19 of these infants, subsequent vitamin A status was monitored at ages 6-12 mo and was found to be comparable with that of older children and adults, regardless of the vitamin A content of the formula fed during hospitalization.(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of Variance↗
PubMed2006

Growth of breast-fed and formula-fed infants.

Growth and nutrition during infancy are being viewed with renewed interest because of the possibility that they may be linked to cardiovascular and metabolic health in later life. Of particular interest are differences between breast- and formula-fed infants with regard to nutrient intake and growth because breastfeeding has been shown to be associated with a reduced risk of obesity in later life. During the first 6-8 weeks of life there is little difference in growth (gain in weight and length) between breast- and formula-fed infants. However, from about 2 months of age to the end of the first year of life formula-fed infants gain weight and length more rapidly than breast-fed infants. There are no consistent differences in adiposity during the first 4-5 months of life, but during the later part of the first year of life the preponderance of the evidence suggests that breast-fed infants are leaner than formula-fed infants. Formula-fed infants at 4-5 months of age show higher plasma levels of insulin-like growth factor-1 (IGF-1), insulin and certain amino acids than breast-fed infants. Whereas the protein intake of breast-fed infants decreases with age and closely matches the requirements for protein during the early months of life, the protein intake of formula-fed infants exceeds requirements after the first 1-2 months of life. The data are consistent with the hypothesis that differences in protein intake are mainly responsible for differences in growth between breast- and formula-fed infants. Differences in energy intake probably are responsible for differences in adiposity observed in older infants.

Body Composition↗
PubMed1997

Visual acuity, erythrocyte fatty acid composition, and growth in term infants fed formulas with long chain polyunsaturated fatty acids for one year. Ross Pediatric Lipid Study.

The CNS and the retina are enriched in long chain polyunsaturated (LCP) fatty acids, specifically docosahexaenoic acid (DHA, 22:6n-3) and arachidonic acid (AA, 20:4n-6), which are present in human milk but not in most infant formulas. In the present study of 134 formula-fed and 63 breast-fed infants, we prospectively evaluated whether providing a source of DHA and AA or DHA alone in formula would increase red blood cell (RBC) phospholipid levels of these fatty acids, enhance visual function, or affect growth during the first year. Healthy term infants < 7 d old were randomized to be fed formulas containing linoleic acid (approximately 10% kcal) and alpha-linolenic acid (approximately 1% kcal) plus (1) no added LCP fatty acids (control formula), (2) DHA (0.12 wt% fatty acids) and AA (0.43 wt%) from egg yolk phospholipid (AA + DHA formula), or (3) DHA (0.2 wt%) from fish oil (DHA formula). A breast-fed group was studied concurrently and permitted formula supplementation after 3 mo. Visual acuity was measured using both the acuity card procedure and a visual evoked potential method at 2, 4, 6, 9, and 12 mo. Infants fed the control formula had 10-40% lower RBC levels of DHA and AA than infants in the breast-fed group. Infants fed the AA + DHA formula had levels of both LCP within approximately 10% of the values for infants in the breast-fed group, and infants fed the DHA formula had 25-55% higher DHA levels and 15-40% lower AA levels. There were no differences in growth or in visual function during this 12-mo feeding study.

Anthropometry↗
PubMedDate not supplied

Folate nutrition is optimal in exclusively breast-fed infants but inadequate in some of their mothers and in formula-fed infants.

Plasma concentrations of folate were studied in a group of exclusively breast-fed infants and their mothers (their numbers gradually decreased from 200 at birth to 7 at 12 months) and in infants completely weaned to a cow's milk formula (containing 35 micrograms of folate/L) and solid foods. The exclusively breast-fed infants were in no danger of folate deficiency; their plasma levels were elevated after the age of 2 months and, on average, were 2.0-3.3-fold higher than maternal levels throughout the study. None of these infants had an inadequate plasma concentration, whereas up to 5% of the mothers had values less than or equal to 3 micrograms/L, despite supplementation during lactation with 0.1 mg folate/day. In the formula-fed infants, 69-94% of the plasma folate concentrations lay below the lowest concentration for the breast-fed infants. Although no infant had signs of anemia or macrocytosis in red cell indices, the infants weaned earliest had the lowest hemoglobin concentrations (p = 0.09) and the highest mean corpuscular volume (MCV) values (p = 0.06) at 9 months of age. Thus, an infant fed a formula containing the recommended amount of folate runs a risk of folate deficiency.

Age Factors↗
PubMed1990

Food and nutrient intake of 6- to 12-month-old infants fed formula or cow milk: a summary of four national surveys.

Food and nutrient intakes of infants during the second 6 months of life were summarized with the use of four national surveys as the data base. Three of the surveys, the second National Health and Nutrition Examination Survey (1976-1980), the Ross Nutrition Survey (1984), and the U.S. Department of Agriculture Nationwide Food Consumption Survey (1977-1978), summarized and compared the nutrient composition of the diets of infants fed formula with that of the diets of infants fed cow milk during the second 6 months of life. The Gerber Nutrition Survey (GNS) summarized the nutrient composition of the diets of infants fed formula, cow milk, or human milk, or a combination of these, during 1986. Iron-fortified formula with beikost provided adequate but not excessive intakes of all nutrients for infants during the second 6 months of life with the possible exception of calcium for older infants. In contrast to cow milk, formula provided readily absorbed and adequate iron, generous linoleic acid, and adequate but not excessive intakes of protein, phosphorus, sodium, and potassium. The distribution of energy between protein, carbohydrate and fat, and potential renal solute load was reasonable in infants fed formula. Cow milk with beikost provided low intakes of readily bioavailable iron and linoleic acid and high intakes of protein, calcium, phosphorus, sodium, potassium, and potential renal solute load during the second 6 months of life. The diets of infants fed low-fat milks were even lower in linoleic acid and higher in volume of food consumed, protein, calcium, phosphorus, sodium, potassium, and potential renal solute load than the diets of infants fed whole cow milk. Apparently, infants fed cow milk were treated differently than those fed formula (i.e., they were given more solids and table foods and less baby food at all ages and less volume of milk at 9 and 12 months of age). These data provided the basis for the development of practical suggestions for feeding infants during the second 6 months of life.

Animals↗
PubMed1990

The rediscovery of infant feeding formula with magnetic resonance imaging.

In six newborns, regular infant feeding formula given approximately one-half hour to four hours prior to MR examination, demonstrated a high intensity signal within the infant's stomach, small bowel, and colon. This effect was observed on both 0.5 Tesla and 1.5 Tesla magnets on T1 (SE TR/TE 433-600/20-25) and on T2 (SE TR/TE 1500/30-80) weighted images. Infant feeding formula has the potential to be used as an oral contrast agent for visualization of the newborn gastrointestinal tract. Chloral hydrate and other agents were also tested.

Digestive System↗
PubMed1992

Effect of discharge samples on duration of breast-feeding.

The breast-feeding patterns of 146 women who initiated breast-feeding during their hospital stay were evaluated to determine whether those women who received a hospital discharge package containing a manual breast pump breast-fed their infants for a longer period of time than did women who received a discharge package containing an infant formula. Women were randomly assigned to receive either a specially prepared pack containing a manual breast pump but no infant formula or a commercially available infant formula package. The women were interviewed in the hospital and by computer-assisted telephone interviews at 2, 4, 6, and 8 weeks postdischarge. Information obtained included infant-feeding practices, sociodemographic characteristics, and attitudinal data. Follow-up interviews were completed for nearly 85% of eligible women at each time period. Women who received a discharge pack containing a breast pump but no infant formula continued exclusive breast-feeding for a greater number of weeks (mean = 4.18 weeks) than did women receiving infant formula in their discharge package (mean = 2.78 weeks) (P less than .05). Also, women who indicated that ease of nighttime feeding was an important consideration were more likely to breast-feed over the entire 8-week period if they received the breast pump rather than infant formula (P less than .05). The conclusion is that an easily implemented, low-cost intervention, the inclusion of a breast pump in discharge packages, may increase the duration of breast-feeding.

Adult↗