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Osmotic load from glucose polymers.

Glucose polymer is a carbohydrate source with variable chain lengths of glucose units which may result in variable osmolality. The osmolality of two commercial glucose polymers was measured in reconstituted powder infant formulas, and the change in osmolality of infant milk formulas at the same increases in energy density (67 kcal/dL to 81 and 97 kcal/dL) from the use of additional milk powder or glucose polymers was compared. All samples were prepared from powders (to nearest 0.1 mg), and osmolality was measured by freezing point depression. For both glucose polymers the within-batch variability of the measured osmolality was less than 3.5%, and between-batch variability of the measured osmolality was less than 9.6%. The measured osmolality varies linearly with energy density (p less than 0.001) and was highest in infant formula reconstituted from milk powder alone. However, there exist significant differences in the measured osmolality between different glucose polymer preparations. At high energy densities (greater than or equal to 97 kcal/dL), infant milk formulas prepared with milk powder alone or with the addition of certain glucose polymer preparation may have high osmolality (greater than or equal to 450 mosm/kg) and theoretically predispose the infant to complications of hyperosmotic feeds.

Glucose↗

[The immunogenicity and allergenicity of an experimental cow's milk protein hydrolysate].

Recently hydrolyzed cow milk proteins have been introduced for the production of infant formulas and are available as hypoallergenic infant formulas. To achieve a decrease in antigenicity and allergenicity a protein hydrolysis (mostly enzymatic) is performed. Sera of different groups were tested for IgG and IgE antibody-binding: 31 controls, 36 atopic children, and 20 children with cow milk protein allergy. Histamine release from basophil leucocytes after incubation with the cow milk proteins beta-lactoglobuline and casein, as with the cow milk protein hydrolysate, was determined additionally for five control, 10 atopic, and five cow milk allergic children. IgG binding to cow milk protein and to the hydrolysate was found in the majority of the sera tested. IgE binding was detectable in sera of only five of the 10 cow milk allergic children, despite detection of specific IgE-antibodies against cow milk proteins in all sera. Histamine release by the cow milk hydrolysate was observed for five atopic and two cow milk allergic children. The cow milk hydrolysate demonstrated a decreased but partially conserved antigenic/allergenic potency compared with cow milk proteins.

Adolescent↗

Dietary PUFA for preterm and term infants: review of clinical studies.

Human milk contains n-3 and n-6 LCPUFA (long chain polyunsaturated fatty acids), which are absent from many infant formulas. During neonatal life, there is a rapid accretion of AA (arachidonic acid) and DHA (docosahexaenoic acid) in infant brain, DHA in retina and of AA in the whole body. The DHA status of breast-fed infants is higher than that of formula-fed infants when formulas do not contain LCPUFA. Studies report that visual acuity of breast-fed infants is better than that of formula-fed infants, but other studies do not find a difference. Cognitive development of breast-fed infants is generally better, but many sociocultural confounding factors may also contribute to these differences. The effect of dietary LCPUFA on FA status, immune function, visual, cognitive, and motor functions has been evaluated in preterm and term infants. Plasma and RBC FA status of infants fed formulas supplemented with both n-3 and n-6 LCPUFA was closer to the status of breast-fed infants than to that of infants fed formulas containing no LCPUFA. Adding n-3 LCPUFA to preterm-infant formulas led to initial beneficial effects on visual acuity. Few data are available on cognitive function, but it seems that in preterm infants, feeding n-3 LCPUFA improved visual attention and cognitive development compared with infants receiving no LCPUFA. Term infants need an exogenous supply of AA and DHA to achieve similar accretion of fatty acid in plasma and RBC (red blood cell) in comparison to breast-fed infants. Fewer than half of all studies have found beneficial effects of LCPUFA on visual, mental, or psychomotor functions. Improved developmental scores at 18 mo of age have been reported for infants fed both AA and DHA. Growth, body weight, and anthropometrics of preterm and term infants fed formulas providing both n-3 and n-6 LCPUFA fatty acids is similar in most studies to that of infants fed formulas containing no LCPUFA. A larger double-blind multicenter randomized study has recently demonstrated improved growth and developmental scores in a long-term feeding study of preterm infants. Collectively, the body of literature suggests that LCPUFA is important to the growth and development of infants. Thus, for preterm infants we recommend LCPUFA intakes in the range provided by feeding of human milk typical of mothers in Western countries. This range can be achieved by a combination of AA and DHA, providing an AA to DHA ratio of approximately 1.5 and a DHA content of as much as 0.4%. Preterm infants may benefit from slightly higher levels of these fatty acids than term infants. In long-term studies, feeding more than 0.2% DHA and 0.3% AA improved the status of these fatty acids for many weeks after DHA; AA was no longer present in the formula, enabling a DHA and AA status more similar to that of infants fed human milk. The addition of LCPUFA in infant formulas for term infants, with appropriate regard for quantitative and qualitative qualities, is safe and will enable the formula-fed infant to achieve the same blood LCPUFA status as that of the breast-fed infant.

Breast Feeding↗

Flavor variety enhances food acceptance in formula-fed infants.

BACKGROUND: Research in humans and animal models suggests that acceptance of solid foods by infants during weaning is enhanced by early experiences with flavor variety. OBJECTIVE: We tested the hypotheses that the acceptance of novel foods by formula-fed infants could be facilitated by providing the infants with a variety of flavors at the time when beikost is first introduced and that, contrary to medical lore, infants who had previously consumed fruit would be less likely to reject vegetables when first introduced than would infants without such an experience. DESIGN: The infants' acceptance of a novel vegetable (puréed carrot) and a novel meat (puréed chicken) was evaluated after a 9-d exposure period in 3 groups of infants, some of whom had previously consumed fruit. During the home-exposure period, one group was fed only carrots, the target vegetable; a second group was fed only potatoes, a vegetable that differed in flavor from carrots; and a third group was fed a variety of vegetables that did not include carrots. RESULTS: Infants fed either carrots or a variety of vegetables, but not those fed potatoes, ate significantly more of the carrots after the exposure period. Exposure to a variety of vegetables also facilitated the acceptance of the novel food, puréed chicken, and daily experience with fruit enhanced the infants' initial acceptance of carrots. CONCLUSION: These findings are the first experimental evidence to indicate that exposure to a variety of flavors enhances acceptance of novel foods in human infants.

Adult↗

Gastroduodenal motility in neonates: response to human milk compared with cow's milk formula.

It is known that breast milk empties more quickly from the stomach than does infant formula. We studied the difference in gastroduodenal motility between neonates fed with human milk and those fed with infant formula. Twenty-four five- to 36-day-old neonates were fed with mother's breast milk or with a cow's milk-based formula. Postprandial gastroduodenal contractions were recorded manometrically for three hours. Repetitive, high-amplitude nonmigrating contractions were the dominant wave form during the postprandial period. The number of episodes, duration, amplitude, and frequency of nonmigrating contractions were not different following the different feedings. The migrating myoelectric complex, which signals a return to the interdigestive (fasting) state, appeared in 75% of breast milk-fed infants but only 17% of formula-fed infants (P less than .05) within the three-hour recording period. Because contractions were similar following the two meals, but a fasting state recurred more rapidly in breast-fed infants, we conclude that factors other than phasic, nonpropagated antroduodenal contractions were responsible for the differences in gastric emptying between breast milk and formula.

Adult↗

Volatile N-nitrosamines in dried foods.

An investigation was carried out to determine the levels of volatile N-nitrosamines in several dried food commodities such as malt, instant skim milk powder, infant formula containing milk powder, instant coffee, soup and soup bases, and baby cereals. The method involves vacuum distillation of the sample from 3N KOH or 1% sulfamic acid, followed by extraction of the aqueous distillate with dichloromethane. The dichloromethane extract is then washed with an acidic buffer (to remove amines), dried over anhydrous sodium sulfate, concentrated in a Kuderna-Danish concentrator, and analyzed by gas-liquid chromatography, using a thermal energy analyzer. Detection limit is 0.1-0.5 ppb. Of the samples analyzed thus far, all malts (22 samples) and instant skim milk powders (11 samples ) were positive for N-nitrosodimethylamine (NDMA); average levels were 7.4 ppb (1.3-67.0 ppb) and 0.4 ppb (0.3-0.7 ppb), respectively. Traces of NDMA and/or N-nitrosopyrrolidine were also detected in 3 of 20 dried soups and 5 of 10 instant coffees analyzed. Traces of NDMA and/or N-nitrosopiperidine (NPIP) were detected in 3 of 8 powdered instant formulas. All for baby cereal samples were negative. The identity of NDMA in 14 samples of malt and that of NDMA and NPIP in a infant formula was confirmed by gas liquid chromatography-mass spectrometry; identity of N-nitrosamines in 3 instant coffees and 1 infant formula was independently verified by high pressure liquid chromatographic analysis.

Chromatography, High Pressure Liquid↗

The influence of dietary palmitic acid triacylglyceride position on the fatty acid, calcium and magnesium contents of at term newborn faeces.

The distribution of long-chain saturated fatty acids in triglycerides is different in infant formulas to that in human milk. In human milk, palmitic acid is predominantly esterified in the sn-2 position (beta-position) of the triglycerides, whereas in infant formulas, it is esterified mainly in the sn-1,3 positions (alpha,alpha'-positions). The specific distribution of the fatty acids in the triglyceride plays a key role in lipid digestion and absorption. We studied fatty-acid, calcium and magnesium composition in the faeces of three groups of at term newborn infants fed different diets: Group A (n=12) was fed from birth to 2 months with human milk (66% palmitic acid in beta-position), Group B (n=12) was fed with formula alpha (19% palmitic acid esterified in beta-position) for 2 months, and Group C (n=12) was fed with formula alpha during the first month and with formula beta (44.5% palmitic acid in beta-position) during the second month. Samples were taken at the end of the first month (t0) and at the end of the second month (t1). Groups A and C presented significantly lower contents of palmitic acid in faeces at t1 than at t0, whereas in Group B, amounts remained similar. Faecal calcium in Groups A and C decreased in the second month (t1), although the fall was no statistically significant. In Group B, calcium amounts showed no change. We found that infant formula beta when compared with infant formula alpha reduced significantly the contents of total fatty acids and palmitic acid in faeces. We conclude that palmitic acid in beta-position is, therefore, beneficial for term infants.

Calcium↗

Effect of human milk and infant milk formulae on adherence of Giardia intestinalis.

Human milk was shown to inhibit adherence of Giardia at concentrations as low as 0.5%. Unsaturated fatty acids were also found to cause significant inhibitory effects on adherence, with ED50 values less than 1 microM for arachidonic, linoleic and palmitic acids. A variety of infant feeding formulae derived from cow's milk and soy bean had suppressive effects on adherence. These observations may explain in part the low prevalence of giardiasis in young infants.

Animals↗

Growth during the first 6 months of life in infants using formula enriched with Lactobacillus rhamnosus GG: double-blind, randomized trial.

BACKGROUND: Probiotic bacteria have beneficial effects on the immune system and gastrointestinal tract, but the impacts of their long-term consumption on health and growth in early infancy are not well documented. The aim of this study was to evaluate the influence of Lactobacillus rhamnosus GG (LGG)-enriched formula on growth and faecal microflora during the first 6 months of life in normal healthy infants. MATERIALS AND METHODS: One hundred and twenty healthy infants (up to 2 months) received LGG-supplemented formula or regular formula in a double-blind, randomized manner until the age of 6 months. Weight, length and head circumference were measured monthly and transformed into standard deviation scores (SDS). Faecal samples were obtained from a random sample of infants (n=25) at entry and at the end of the study. RESULTS: One hundred and five infants (51 in the LGG group) completed the study. Children receiving LGG-supplemented formula grew better: their changes in their length and weight SDS (DeltaSDS) at the end of the study were significantly higher than those receiving regular formula (0.44+/- 0.37 versus 0.07+/- 0.06, P< 0.01 and 0.44+/- 0.19 versus 0.07+/- 0.06, P< 0.005, respectively). The LGG group had a significant, higher defecation frequency 9.1+/-2.06 versus 8.0+/- 2.8 (P<0.05). More frequent colonization with lactobacilli was found in the LGG group, 91% versus 76% (P<0.05) at the end of the study. CONCLUSIONS Infants fed with LGG-enriched formula grew better than those fed with regular formula. Further studies are necessary to clarify the mechanism of LGG in infant growth.

Double-Blind Method↗

Dose-response study of RIT 4237 oral rotavirus vaccine in breast-fed and formula-fed infants.

The RIT 4237 live attenuated bovine rotavirus vaccine was given orally at three dose levels to 75 breast-fed, 40 formula-fed and 24 fasting infants ages 4 to 6 months. Vaccine of 10(8.3) (50% tissue culture-infective doses) (TCID50) per dose gave a neutralizing antibody response in 14 of 14 (100%) formula-fed, in 18 of 26 (69%) breast-fed and in 5 of 8 (63%) fasting infants, or an overall response rate of 77% (37 of 48). The overall response rate to a vaccine of 10(7.2) TCID50 per dose was 61% (33 of 49), or slightly but not significantly lower than that at the higher dose level. On the other hand a vaccine of 10(6.3) TCID50 per dose gave a significantly (P less than 0.01) lower composite response rate of 33% (14 of 42). The overall serologic response rate to the vaccine at the two higher doses was somewhat better (24 of 28, 86%) in formula-fed infants than in breast-fed infants (37 of 52, 71%). However, the response rate of the breast-fed infants can also be considered satisfactory. Thus the current recommendation for use of the RIT 4237 vaccine would be administration of a dose of at least 10(8) TCID50 after feeding with either formula or breast milk.

Administration, Oral↗

Formula allergy and intolerance.

There are two major types of adverse reactions in infant formulas: (1) formula allergy/hypersensitivity, which is an immunologic response, and (2) formula intolerance, which is a nonimmunologic response. Formula intolerance can occur in infants with an underlying congenital or acquired enzyme deficiency (disaccharidase deficiency, galactosemia, hereditary fructose intolerance). The clinical presentation, diagnosis, and treatment of both reactions are reviewed in this article. The appropriateness of the use of a variety of infant formulas is discussed. Guidelines for the prevention of allergic disease are described as well.

Carbohydrate Metabolism, Inborn Errors↗

Retina fatty acid composition of piglets fed from birth with a linoleic acid-rich vegetable-oil formula for infants.

The effects of a vegetable-oil-based formula containing 30% 18:2n-6 (18:2 omega-6), 0.8% 18:3n-3, and no n-6 or n-3 long-chain polyunsaturated fatty acids (LCPs) on retina total lipid, ethanolamine phosphoglyceride (EPG), and phosphatidylcholine (PC) fatty acid composition were studied in neonatal piglets. Term-gestation piglets were fed sow milk (SMF) or the formula (FF) from birth for 5, 10, 15, or 25 d. After 25 d feeding, the 22:6n-3 was reduced by 24% in total lipid, 20% in EPG, and 28% in PC of retinas of FF relative to SMF piglets. A compensatory increase in 22:4n-6 and 22:5n-6 concentrations occurred in retina total lipid, EPG, and PC of FF animals. The data suggest that the exclusive feeding of formulas devoid of LCPs and high in 18:2n-6 and/or 18:2n-6 and 18:3n-3 compromises normal accretion of 22:6n-3 in neonatal piglet retina. The potential reversibility of these changes or their effects on vision are not known.

Animal Feed↗

Effect of high-pressure processing on strains of Enterobacter sakazakii.

Four strains of Enterobacter sakazakii were inoculated into tryptic soy broth and reconstituted powdered infant formula and exposed to high-pressure processing. Pressures of 200, 400, and 600 MPa were used for each medium for 1 min. E. sakazakii was reduced by more than 6 log (strains A and B) in both media at 600 MPa. Strain B was significantly (P < or = 0.05) more pressure resistant than the other strains, with just more than a 3-log reduction at 600 MPa in both media. The reconstituted infant formula has a significant (P < or = 0.05) protective effect for certain strains and pressures (strain B at 400 MPa and strain D at 400 and 600 MPa). Differences in log reductions between media (milk and broth) were also observed for certain strains and specific pressures (strain B at 400 MPa and strain D at 400 and 600 MPa; P < or = 0.05). This research showed that E. sakazakii, when present in reconstituted powdered infant formula, can be submitted to high-pressure processing (600 MPa for 1 min) and achieve log reductions ranging from 3 to 6.84, depending on the strain.

Colony Count, Microbial↗

[Clinical experience with a hydrolyzed soy formula in infants with protracted enteritis and atopic eczema].

A lactose-free soy and beef hydrolysate based formula ("Pregomin" Milupa) was studied in 12 infants affected with protracted enteritis and in 10 infants affected with atopic eczema. After 1 month of treatment with "Pregomin" an oral provocation test was performed using intact soy protein. The aim of this latter test was to evaluate if the hydrolysed soy formula could cause allergic sensitization to soy protein. We obtained the following results in the group of infants with enteritis: good catch-up growth, malnutrition laboratory test improvement, negative allergic tests, positive oral provocation test in only one infant who had been previously fed with intact soy protein. In the group with atopic eczema we found an improvement of the eczema, negative allergic tests, 3 out of 9 positive oral provocation tests (in infants previously fed with soy protein based formulas). Our data show that "Pregomin" formula was effective both from a gastroenterological point of view and from an allergological one. Furthermore we did not observe any positive oral provocation test with soy protein in infants who had never been exposed to this type of protein. The latter result seems to demonstrate that "Pregomin" formula does not possess any allergenic properties.

Dermatitis, Atopic↗

Fasting gastric fluid and fecal polyamine concentrations in premature infants.

BACKGROUND: The role of milk polyamines in the development of the gastrointestinal tract of human infants is presently unknown. Polyamine concentrations are higher in human milk than in infant formulas. The aim of the present study was to gather data on luminal polyamines by measuring gastric fluid and fecal polyamine concentrations in premature infants during the postnatal period. We further compared gastric fluid polyamine concentrations with those reported for milk and looked for possible relationships between luminal polyamine concentrations, age, and growth rate. METHODS: High-performance liquid chromatography was used for the measurement of polyamine concentrations in both fecal and gastric fluid samples. RESULTS: Ninetieth centiles for gastric polyamines during the first week were 62, 28, 82, and 14 microM for putrescine, spermidine, spermine, and cadaverine, respectively. These values are higher than those reported for human milk and infant formulas. Polyamine concentrations were unrelated to either age or growth rate. Ninetieth centiles for fecal polyamines during the first week were 7668, 5176, 53, and 75 microM for cadaverine, putrescine, spermidine, and spermine, respectively. CONCLUSIONS: Fasting gastric fluid polyamine concentrations in premature infants are higher than those reported for either human milk or infant formulas. The high fecal cadaverine and putrescine concentrations are probably of bacterial origin.

Aging↗

[The significance of iron in development and nutrition of infants. II. Prevention of iron deficiency].

The symptoms and consequences of iron deficiency in the child are described as found in the literature. The role of iron in immune processes is presented and it is noted that there is no proof for the theory of the development of bacterial infections as a result of giving oral iron supplements. The influence of breast milk and cow milk on the intestinal uptake and loss of iron is discussed. Feeding infants formulae or milk-substitute formulae after cessation of breastfeeding prevents the increased blood loss in the digestive tract, which results from the introduction of cow's milk. The iron content of selected Polish infant formulae, follow-on formulae and milk-substitute formulae available on the market are given and compared with FAO, WHO, ESPGAN and EC recommendations. Results of the authors' own researches on the iron content of selected Polish powdered whole cow's milks are presented. The measurements, made by atomic absorption spectroscopy (AAS), showed that iron content of whole powdered milks ranged from 0.23 to 1.19 mg/dm3. The values do not vary significantly from those in the literature on the iron content of unboiled cow's milk. It is shown that up to the point of the doubling of birth weight, formula-fed infants should be fed modified milk containing at least 2 mg/dm3 of iron. Thereafter infants should receive milk containing at least 7 mg/dm3 of iron.

Adolescent↗

Hypersensitivity to hydrolyzed cow's milk protein formula in infants and young children with atopic eczema/dermatitis syndrome with cow's milk protein allergy.

PURPOSE: Atopic eczema/dermatitis syndrome (AEDS) is often the first manifestation of atopic disease in children. Food hypersensitivity should be considered in approximately 40% of these patients. AEDS children with cow's milk allergy are commonly prescribed a hydrolyzed formulas or amino acid-based formulas for an alternative protein source. The aim of this study was to investigate hypersensitivity to extensive hydrolyzed casein and whey proteins in AEDS children with cow's milk protein allergy (CMA). MATERIAL AND METHODS: The study included 67 hospitalized children with AEDS (m/f--43/24), aged 1-28 months (mean 11.34 +/- 8.52) and CMA confirmed by oral food challenge. All patients were treated with extensively hydrolyzed formulas: 48/67 children with casein hydrolysates and 19/67 children with whey hydrolysates. RESULTS: In most of studied children we recognized severe AEDS (SCORAD Index: mean 55.41 +/- 17.4; 95% CI 51.17-59.66) with elevated total IgE (mean 432.98 +/- 1030.46; 95% CI 181.63-684.33). In 22/67 children (32.8%) we established diagnosis of hypersensitivities to hydrolyzed formula (HHF): in 17/22 to casein hydrolysates, in 4/22 to whey hydrolysates and in 1/22 to amino-acid based formula. Children with HHF did not differ in the severity of AEDS evaluated by SCORAD (57.18 +/- 16.59 vs 54.56 +/- 17.90), the serum level of total IgE (603.9 +/- 1253 vs 349.4 +/- 906.1) and the time of breast-feeding (4.4 +/- 4.0 months vs 6.8 +/- 7.28). They differ in the number of plasma eosinophils and positive correlation between number of eosinophils and serum level of total IgE (p<0.05, r=0.46 vs r=0.07). CONCLUSIONS: Children with moderate or severe atopic eczema/dermatitis syndrome can demonstrate hypersensitivity to hydrolyzed formula recommended for therapeutic indications.

Allergens↗