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PubMed1992

Medium chain triglyceride in the therapy of gastroesophageal reflux.

Carbohydrate solutions that empty rapidly from the stomach have been shown to produce less gastroesophageal reflux (GER) during the postcibal period than more slowly emptying formulas. These observations have not been extended to complete infant formulas containing fat, carbohydrate, and protein constituents. Medium chain triglyceride has been shown to significantly accelerate gastric emptying compared to long chain triglyceride for preterm infants when investigated in commercial infant formulas. Using a previously reported acidified formula model coupled with esophageal pH probe testing, we have documented in a group of 28 infants that modification of formula by enrichment with medium chain triglyceride produced no improvement in rates of GER during the first 2 h after feeding.

Gastroesophageal Reflux↗

PubMed1997

Antiinflammatory effects of human milk on chemically induced colitis in rats.

We examined the effects of a human milk diet on rats with chemical colitis induced with a 4% acetic acid enema. Colonic myeloperoxidase activity was used as a surrogate marker for neutrophil infiltration. Control rats fed rat chow had little colonic myeloperoxidase activity; geometric mean, 0.27 U/g of tissue. Rats with colitis fed rat chow had significantly increased colonic myeloperoxidase activity (geometric mean, 6.76 U/g, p < 0.01 versus no colitis), as did rats with colitis fed infant formula or Pedialyte (geometric mean, 6.92 and 8.13 U/g, respectively, both p < 0.01 versus no colitis). Animals with colitis fed human milk had significantly lower colonic myeloperoxidase activity (geometric mean, 2.34 U/g) than did animals with colitis fed either chow or infant formula (p < 0.001). Similar effects were seen in rats with colitis fed infant formula supplemented with recombinant human IL-1 receptor antagonist (geometric mean, 1.95 U/g). These data show that orally administered human milk has an antiinflammatory effect on chemically induced colitis in rats, which may be mediated in part by IL-1 receptor antagonist contained in human milk.

Acetic Acid↗

PubMed1986

Energy balance in low birth weight infants fed formula of high or low medium-chain triglyceride content.

We tested the effect on energy balance of the partial substitution of medium-chain for long-chain triglycerides in the diet of growing low birth weight infants. Fifteen infants were studied in a randomized double-blind crossover clinical trial in which each infant was fed each of two formulas, which were of equal gross energy and protein content but differed in fat composition. The high medium-chain triglyceride (MCT) formula contained medium- and long-chain triglycerides in a weight/weight ratio of 46:54; in the low MCT formula the ratio was 4:96. The hypothesis tested was that under conditions of equal gross energy intake the two diets would differ in their digestible and metabolizable energy contents and would produce differences in the infants' rates of energy expenditure and energy storage. Gross energy intakes averaged 562 and 555 kJ/kg/day (134 and 133 kcal/kg/day) with the high and low MCT formulas, respectively. With each diet, coefficients of energy digestibility (0.93) and metabolizability (0.91) were identical; the rates of energy expenditure were 262 (high MCT) and 265 (low MCT) kJ/kg/day (63 kcal/kg/day for both diets), and of energy storage were 246 (high MCT) and 239 (low MCT) kJ/kg/day (59 and 57 kcal/day). These differences were not significant. There were also no significant differences between the two diets in coefficients of nitrogen retention (mean 0.70) or in rate of weight gain (mean 21.5 gm/kg/day). The use of high MCT content in infant formula neither provided a nutritional advantage in energy digestibility or metabolizability nor resulted in an increased rate of energy expenditure or of energy storage.

Body Weight↗

PubMed1987

Studies on LHRH and physiological fluid amino acids in human colostrum and milk.

Various physiological fluid amino acids including essential, nonessential and neuroinhibitory as well as excitatory entities in human milk, colostrum, and infant formula were determined on a microcolumn ion-exchange analyzer equipped with ninhydrin detection system and integrator. The levels of 6 essential and 6 nonessential amino acids were significantly lower in infant formula than those in milk and colostrum. The neurotransmitter amino acids were also high in milk except taurine. Peptide hormones like LHRH were undetectable in infant formula, but were found in appreciable quantities in milk and colostrum by high pressure liquid chromatography. LHRH levels in milk were 6 to 7 fold higher than the corresponding plasma values as measured by radioimmunoassay. These and other several unique ingredients in human breast milk play a very prominent role in the development of the neonate. The presence of such complex components makes it impossible to humanize cow's milk or any other alternate formulation and to serve as a substitute for human milk. Further extensive work in defining the role of such essential components in milk on the development of the infant is indicated.

Amino Acids↗

PubMedDate not supplied

Omega-3 fatty acid supplementation in perinatal settings.

The purpose of this article is (a) to explain the role of omega-3 fatty acids in human health, specifically in fetal/neonatal development, (b) to summarize the recent research behind the innovations in infant formula manufacturing and advertisement of omega-3 fatty acid supplementation for pregnant and lactating mothers, and (c) to relate the research findings to clinical practice. Omega-3 fatty acid supplementation in perinatal settings is discussed here from three vantage points: (a) supplementation of the third-trimester pregnant woman to enhance fetal development, (b) supplementation of the lactating mother to enhance development of the breastfeeding infant, and (c) supplementation of infant formulas to enhance development of the bottle-feeding infant. Supplementation can occur by increasing one's intake of foods high in omega-3 fatty acids or by ingesting fatty acid nutritional supplements. The challenge of supplementation for vegan and vegetarian women is also addressed.

Animals↗

PubMed1997

Duodenal motor responses in preterm infants fed formula with varying concentrations and rates of infusion.

Feeding intolerance is frequently reflected in preterm infants by delayed gastric emptying. Gastric emptying is delayed by the physical characteristics of ingested nutrient as well as the rate of feeding. Because gastric emptying is dependent upon duodenal function, the present studies were undertaken to assess duodenal motor responses to feeding of differing nutrient content and rate of feeding. Using a Latin square design we recorded duodenal motor responses in 14 preterm infants given four test feedings in random order over 18 h. Three were given as a 120-min infusion containing no nutrient, a 10 cal/oz formula, and a 20 cal/oz formula. The fourth test feeding consisted of a 20 cal/oz formula given as a bolus over 15 min. Although caloric density was altered, osmotic load and nutrient proportions of the formulas were not. Motor responses were recorded using a low compliance continuous perfusion manometric system. When infants were fed "water" and half-strength formula as a slow infusion, they demonstrated little or no duodenal motor response to feeding. When these infants were fed full-strength formula as a slow infusion, they displayed a brisk increase in motor activity (p < 0.05), but profound motor quiescence when fed the same volume by bolus over 15 min (p < 0.05). Of the four test feedings, only full-strength formula given as a slow infusion triggered adult-like duodenal motor responses to feeding. We speculate that feedings of full-strength formula given slowly by infusion will improve feeding tolerance.

Duodenum↗

PubMed1993

Development of thyroid gland volume during the first 3 months of life in breast-fed versus iodine-supplemented and iodine-free formula-fed infants.

The spontaneous development of thyroid gland volume (TGV) during the first 3 months of life was studied in entirely breast-fed infants (n = 21) and compared to those fed an iodine-supplemented formula (n = 19), an iodine-free formula (n = 5), or partially breast-fed in addition to an iodine-free (n = 4) or an iodine-supplemented formula (n = 16). The TGV of the infants and their mothers was determined sonographically in addition to their urinary iodine concentrations 5-7 days postpartum and 3 months later. In ten additional lactating mothers the breast milk concentrations of thyroid hormones and iodine were determined. It was shown that at 3 months of age an infant consuming about 1000 ml breast milk per day receives about 2 micrograms thyroid hormones and 55 micrograms iodine per day. At the end of their first week of life the infants showed a TGV between 0.28 and 1.5 ml (median 0.61 ml) and a urinary iodine concentration between 0.03 and 16.3 micrograms/dl (median 3.0 micrograms/dl). At 3 months of age the TGV of the breast-fed infants had decreased by a median of 0.24 ml (= -34%; median of percentage changes) whereas those fed a formula without iodine had increased by a median of 0.26 ml (= +50%; median of percentage changes). Those receiving an iodine-supplemented formula showed a TGV reduction of 0.14 ml (= +2%; median of percentage changes). The TGV development of the partially breast-fed infants lay between those being exclusively breast or formula fed.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed2001

Randomized clinical trials in infancy: methodologic issues.

Randomized clinical trials of early nutritional interventions in infants are necessary to establish safety and efficacy of supplementation of infant formulas with LCPUFAS for term and preterm infants. Such trials pose significant methodologic difficulties when applied to infants because of the rapidly changing development of the infant's central nervous system and its interdependence with multiple environmental factors. Current assessments of infant cognitive development in the first year of life lack stability and predictive relationships to later outcomes. Thus, intervention trials need to extend beyond the first two years of life. Small sample sizes, high attrition rates, and lack of attention to confounding variables known to be related to child outcomes are additional problems in the majority of studies to date, especially for preterm populations. Attention to selection and attrition biases and the roles of mediating and moderating factors in affecting intervention effects are also necessary to determine the benefits vs risks of LCPUFA supplementation of infant formula.

Breast Feeding↗

PubMed1991

Infant diet and salmonellosis.

BACKGROUND: The Island of Guam has experienced a high incidence of infant salmonellosis for a number of years (age-specific incidence rate of approximately 3700 cases per 100,000 infants in 1984). Interviews of case parents suggested that the use of high-iron infant formula was associated with this problem. METHODS: A case-control study was conducted to test this hypothesis. Information on feeding practices and a variety of medical and socioeconomic factors was collected for 78 laboratory-confirmed Salmonella-case infants and 167 control infants. RESULTS: Case infants were less likely to have been breast-fed (odds ratio [OR] = 9.15; 95% confidence interval [CI] = 2.71-30.9) and more likely to have been fed infant formula with an iron content of 10 mg/L or greater (OR = 2.96; 95% CI = 1.24-7.08) than were control infants. CONCLUSIONS: Although the precise means by which infants are most commonly exposed to Salmonella bacteria remain obscure, breast-feeding apparently protects against the development of physician-diagnosed clinical salmonellosis, while the feeding of high-iron infant formula has the opposite effect.

Breast Feeding↗

PubMed1990

An evaluation with piglets of bovine milk, hydrolyzed bovine milk, and isolated soybean proteins included in infant milk formulas. I. Effect on organ development, digestive enzyme activities, and amino acid digestibility.

A study, using the piglet as a model for the human infant, was undertaken to determine the effect of the protein source of a milk formula on organ development, the activity of digestive enzymes, and the absorption of amino acids as measured at the terminal ileum and over the entire digestive tract. Three isocaloric liquid milk formulas containing equal amounts of either intact bovine milk, hydrolyzed bovine milk, or isolated soybean protein as the sole source of this nutrient and with equal levels of fat and carbohydrate were each given to six 14-day-old piglets over a 19-day period in a manner that mimicked human infant feeding practice. Following a 6-day metabolism study, the piglets were killed, their organs removed, and samples of digesta collected. The protein source of the milk-based formula did not affect (p greater than 0.05) the weight/unit body weight of the small intestine, large intestine, liver, or pancreas, but the relative weight of the kidneys was lower (p less than 0.05) for animals fed the intact bovine milk-based formula and that of the stomach was higher (p less than 0.01) for piglets receiving the isolated soybean formula. The activities of pepsin, intestinal trypsin and chymotrypsin and pancreatic chymotrypsin were not influenced (p greater than 0.05) by protein source, but piglets receiving the bovine milk-based formula had a lower level of activity (p less than 0.01) for pancreatic trypsin. The apparent ileal and fecal absorption of nitrogen was similar for the three milk-based formulas, the overall mean ileal absorption of nitrogen (+/- SE) being 89.0% (+/- 1.44). Excluding cystine, where ileal absorption was relatively lower (p less than 0.05) with the isolated soybean formula (86.7%) compared with the intact bovine milk (91.5%), protein source had little effect on the apparent absorption of essential amino acids. It was concluded that the replacement of intact cow's milk protein in human infant formulas by either hydrolyzed cow's milk or isolated soybean protein is unlikely to cause any major disturbance in the digestive process.

Amino Acids↗

PubMed1985

Continuous gastric pH measurement in young and older healthy preterm infants receiving formula and clear liquid feedings.

Gastric pH was recorded with an intragastric pH electrode for 12 h in two groups of healthy, preterm infants with similar birth weights (range 1.4 to 2.0 kg). Group I infants (n = 13) were less than 7 days old and Group II infants (n = 10) were 7-15 days old. Infants were fed three formula feedings and one clear liquid feeding during the study. In Group I, mean gastric pH measured at 15-min intervals was above 4.0 for 3 h after either feeding. In Group II mean gastric pH was lower particularly after clear liquid feedings, where it remained below pH 4.0 for the entire 3-h postprandial period. The percent of monitored time at gastric pH less than 4.0 was low in Group I--15.2 +/- 4.2% and 20.6 +/- 6.4% after formula and clear liquid, respectively. The percent time was greater in Group II--42.7 +/- 8.0% and 61.9 +/- 7.3% after formula and clear liquid, respectively. In the younger preterm infant, gastric pH does not appear sufficiently low to support peptic activity.

Age Factors↗

PubMed1988

The susceptibility of breast-fed and cow's milk formula-fed infant guinea pigs to upper respiratory tract infection with influenza virus.

Breast-fed infant guinea pigs from immune mothers were partially protected against infection with influenza virus when compared to those from nonimmune mothers. Virus titres in nasal washes at 24 h post-infection were reduced and virus clearance from the upper respiratory tract accelerated. When infants of immune mothers were deprived of colostrum and hand-reared on a formula-feed their ability to reduce virus yields at 24 h post-infection was lost. Infants partially breast-fed and partially formula-fed gave total virus yields similar to their fully breast-fed peers. Infants of immune mothers possessed high titres of serum IgG antibody to the virus prior to infection. Post-infection, IgG antibodies appeared on the mucosal surface of breast-fed seropositive infants earlier than for seronegative infants of nonimmune mothers but IgM and IgA responses of seropositive infants were less vigorous than those of seronegative infants. There was little evidence that antibody present in a mother's milk was transmitted to the nasal mucosa of her offspring. Fully and partly formula-fed seropositive infants showed enhanced transudation of serum IgG antibody on to the mucosal surface and this effect was most marked in the partly formula-fed group which showed greater protection. In both formula-fed groups serum and nasal IgM and IgA responses were completely suppressed.

Animals↗

PubMed2005

Growth of breast-fed and formula-fed infants compared with national growth references of Thai children.

OBJECTIVE: To compare the growth patterns of breast-fed (BF) and formula-fed (FF) infants with national growth references of Thai children and to determine whether the Thai growth references can be used to assess growth of BF infants who were fed according to Thai guidelines of infant feeding. DESIGN: Cohort study. MATERIAL AND METHOD: One hundred and fifty six term infants (78 BF and 78 FF infants) were followed prospectively for 12 months. Milk was the only food source during the first 4 months and solid foods were introduced after 4 months of age. Body weight, length and head circumference were measured at the age of 1, 2, 4, 6, 9 and 12 months. RESULTS: Of the 156 infants, 140 completed the study (71 BF and 69 FF infants). BF and FF infants had similar mean weight and length from 0 to 6 months, thereafter BF infants had lower weight and length than FF infants with significant difference at 9-12 months in male infants and at 12 months in female infants (p < 0.05). Compared with national growth references of Thai children, mean weight and length of BF and FF infants in the study were significantly lower than the mean values of Thai infants from 0 to 1 months, thereafter mean weight and length of BF infants were close to the Thai references but those of FF infants were higher than the Thai references after 6 months with significant difference in weight from 9 to 12 months and length at 12 months. The incidence of malnutrition and obesity at 1 year of age was not different between the two feeding groups. Inadequate complementary food was the risk factor of infant malnutrition (adjusted RR 4.7, 95% CI 1.1-21.9, p 0.04). CONCLUSION: BF and FF infants had similar weight and length from birth to 6 months, thereafter, FF infants had higher weight and length than BF infants and Thai growth references. Growth of BF infants correlated well with the national growth references of Thai children, so the Thai growth references can be used to assess growth of BF infants who were fed according to Thai guidelines of infant feeding.

Body Size↗

PubMed1982

Effects of increased calcium, phosphorus, and vitamin D intake on bone mineralization in very low-birth-weight infants fed formulas with Polycose and medium-chain triglycerides.

The ideal postnatal rate of bone mineralization in preterm infants is unknown. In this study the effect of a new formula on bone mineralization in very low-birth-weight infants (28 to 32 weeks' gestation) was studied using infant-adapted direct photon absorptiometry. The 81 calories/dl experimental formula (Similac Special Care) contained 50% of the carbohydrate as Polycose, 50% of the fat as medium-chain triglycerides, and a whey:casein protein ratio of 60:40. It also contained large amounts of calcium (140 mg/dl), phosphorus (75 mg/dl), and vitamin D (120 IU/dl). Over a three- to five-week period, bone mineralization increased in two-thirds of the infants and decreased in the remainder, but all values remained in the range expected for bone mineral content in utero. Serum calcium, phosphate, magnesium, alkaline phosphatase, 25-hydroxy-vitamin D, and parathyroid hormone concentrations remained stable, whereas calcitonin concentrations fell.

Bone and Bones↗

PubMed2005

Ghrelin, leptin and IGF-I levels in breast-fed and formula-fed infants in the first years of life.

AIM: To establish ghrelin, leptin and IGF-I serum levels in breastfed (BF) and formula-fed (FF) infants during the first period of life. METHODS: A cross-sectional study was conducted on fasting blood venous samples obtained from exclusively BF (n=106) and FF (n=100) infants to measure total ghrelin (RIA test), leptin (RIA test) and IGF-I (chemiluminescence). Anthropometrical measurements of weight, length and cranial circumference were performed. RESULTS: During the first 4 mo of life, FF infants compared to BF ones showed higher ghrelin levels (2654.86 vs 2132.96 pg/ml; p<0.032), higher IGF-I levels (3.73 vs 3.15 ng/ml; p=0.00) and lower leptin levels (0.68 vs 1.16 ng/ml; p<0.04). Leptin values were higher in females than in males (0.80 vs 0.47 ng/ml; p<0.03), while no gender-related difference was found for ghrelin and IGF-I. No differences were found in anthropometrical measurements comparing the two groups of infants. A multiple regression analysis showed an inverse correlation between ghrelin and leptin values (p<0.04) and between IGF-I and leptin levels (p=0.00). CONCLUSION: Our finding suggests that breastfeeding influences hormones such as ghrelin, leptin and IGF-I in infancy, mainly during the first 4 mo of life. Further evidence is needed to confirm and clarify the role of a protective link from mother to infants as seen in our observations.

Anthropometry↗

PubMed1996

Effect of rice cereal feedings on bone mineralization and calcium homeostasis in cow milk formula fed infants.

OBJECTIVE: We conducted a prospective randomized, single-blinded clinical trial to test the hypothesis that intake of formula plus cereals between the ages of 16 and 26 weeks postnatally (as compared to formula alone) would lead to lower bone mineral content (BMC), higher parathyroid hormone (PTH) concentration, lower serum calcium (Ca), magnesium (Mg) and osteocalcin (OC); and increased continuous night sleep. METHODS: At 16 weeks postnatally, 41 healthy, term infants were randomized to formula alone or formula and cereal. RESULTS: We found no significant differences in growth or sleep pattern, nor in BMC between groups. Serum PTH concentration was significantly increased in the cereal group at 26 weeks. CONCLUSION: We speculate that the increase in PTH is due to relative Ca deficiency or is responsive to increased phosphate load in the cereal group.

Animals↗

PubMed2006

Intake of vitamin D by Finnish children aged 3 months to 3 years in relation to sociodemographic factors.

OBJECTIVE: To study the total daily intake of vitamin D from food and supplements among Finnish children aged 3 months to 3 years, the dietary sources of vitamin D and the association between vitamin D intake and sociodemographic factors. SUBJECTS AND METHODS: The subjects are participants in the Finnish Type I Diabetes Prediction and Prevention Nutrition Study born between October 1997 and October 1998. At the age of 3 and 6 months, 1, 2 and 3 years, 342 (72% of the invited families), 298 (63%), 267 (56%), 233 (49%) and 209 (44%) families, respectively, participated in the present study. Food consumption was assessed by a 3-day food record. A structured questionnaire was used to record the parents' socioeconomic status. RESULTS: The mean dietary vitamin D intake exceeded the recommendation (10 microg/day) at the age of 3 (11.0 microg) and 6 months (12.0 microg), but decreased thereafter being 9.8, 5.0 and 4.1 microg at 1, 2 and 3 years of age, respectively. Among the children 91, 91, 81, 42 and 26% used vitamin D supplements at the age of 3 and 6 months, and 1, 2 and 3 years, respectively. In children not using vitamin D supplements, vitamin D intake was less than 10 microg/day at all ages. Vitamin D intake from food did not differ in children who used and did not use vitamin D supplements. Vitamin D supplements were the main source of vitamin D intake in all age groups studied, followed by vitamin D-fortified infant formula in 3-month-olds and infant formula and baby foods in 6-month-olds. After the age of 1 year, the most important food sources of vitamin D were margarine, fish, baby foods, low-fat milk and eggs. Sociodemographic factors, especially the number of children in the family and maternal age, were associated with the total vitamin D intake and vitamin D supplement use. CONCLUSION: Vitamin D supplements are not used according to the dietary recommendations in a substantial proportion of Finnish children.

Adult↗

PubMed2006

A population-based survey on infant feeding practice (0-2 years) in Hong Kong: breastfeeding rate and patterns among 3,161 infants below 6 months old.

The prevalence of breastfeeding for the first 6 months in infants has been low in Hong Kong since the 1970s. In order to develop effective breastfeeding policies and promotion programs, an appraisal of feeding practices and factors related to initiation and early cessation of breastfeeding is necessary. A survey with a population-based representative sample was conducted to determine social-demographic, personal and cultural factors that influenced decision, duration and practice of infant feeding among infants 0-24 months old. This paper focuses on infants below 6 months old to study factors related to decision, duration and practice of breastfeeding. In 1993, 7,298 healthy infants were recruited from 46 Maternal-and-Child-Health-Clinics (MCHC) throughout Hong Kong, of whom 3161 were below 6 months old. The mother reported her feeding decision, duration and practice in a questionnaire. Breastfeeding rate was found to be very low (8.4%) for infants below 6 months old. Only 50.9% infants were breastfed. Infant formulae were widely given among partially breastfed infants. 45% mothers were full-time employed. Most mothers were aware of the benefits of breastfeeding to the infants and themselves. Husbands (43.3%) were regarded the most influential on initiation and duration on breastfeeding. Restricted food varieties (54%), sore nipple and breast engorgement (67%), perceived home confinement (41.5%) and perceived inadequate milk supply (31.7%) were major concerns upon breastfeeding. Furthermore, 76.9% mothers turned to MCHC staff for advice when they encountered difficulties during breastfeeding. In conclusion, the survey collected population-based representative data on factors determining initiation and early cessation of breastfeeding in Hong Kong in 1993. The findings will serve as a cornerstone in understanding the evolution of breastfeeding practice in Hong Kong. It merits further study to investigate how the confounders interplay to modulate initiation, duration and patterns of breastfeeding.

Adult↗