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PubMed1999

Long-chain polyunsaturated fatty acids in diets for infants: choices for recommending and regulating bodies and for manufacturers of dietary products.

While the scientific evaluation of the physiologic effects, potential benefits, and risks of dietary preformed long-chain polyunsaturated fatty acids (LCPUFA) for infants have been discussed elsewhere, this manuscript addresses some of the resulting consequences and challenges of interpreting the available knowledge from the perspective of recommending and regulating bodies, and of manufacturers of dietary products and their ingredient materials. Traditionally human milk composition has served as a reference point for infant formula design. With respect to the use of LCPUFA in infant formula, much more emphasis than ever before invested for any other group of micronutrients has been put on clinical studies investigating the potential advantages and disadvantages of LCPUFA in infant foods, including growth, safety aspects, and a variety of other outcome measures.

Evaluation Studies as Topic↗
PubMed2001

Prospective cohort studies using hydrolysed formulas for allergy prevention in atopy-prone newborns: a systematic review.

UNLABELLED: The aim of this study is to give a systematic overview on publications having investigated the allergy preventive effect of extensively and/or partially hydrolysed infant formulas. Publications were searched by several strategies. Inclusion criteria were: prospective cohort study, randomisation, family history of atopy of the subjects, follow-up for at least the 1st year of life. Studies were described systematically as to methods, study participants, interventions and co-interventions, and study outcomes. The methodological quality was judged according to an instrument assessing the reduction of bias (score between 0 and 7 points). Data of studies having examined partial hydrolysates are presented as odds ratios. Of 16 studies found, 10 fulfilled the inclusion criteria. Study designs showed considerable differences as to methods, intervention and co-intervention procedures and definition of outcomes. Methodological quality varied between 0 and 6 points. The comparison of exclusively test- and control formula-fed groups showed a uniform tendency towards allergy protection in studies with partial hydrolysates. Study results on the effect of extensive hydrolysates were not comparable because of major differences in study designs. CONCLUSION: More well-designed studies with an adequate statistical power are needed to compare the allergy preventive effect of partially and extensively hydrolysed formulas with a standard infant formula.

Cohort Studies↗
PubMedDate not supplied

Evaluation of single cell sources of docosahexaenoic acid and arachidonic acid: a 4-week oral safety study in rats.

Docosahexaenoic acid (DHA) and arachidonic acid (ARA) are secreted in human milk and consumed by the nursing neonate but are not present in infant formulas currently available in the US. Supplementation of formulas with DHA and ARA may be particularly important for premature infants, who have less accretion of these fatty acids in utero than term infants. Some experts suggest that DHA and ARA should be added to infant formulas. Common sources of these fatty acids (e.g. fish oils, egg yolk lipids) are not optimal for infants in that they contain disproportionate amounts of other fatty acids. This 4-wk study examined the safety of a high-DHA algal oil and a high-ARA fungal oil, blended so that the DHA:ARA ratio approximates that in human milk. Rats were fed the blend at levels representing three, 11 and 22 times the anticipated infant exposure. Control animals were fed either a high-fat diet (13.1%, w/w; equivalent to the fat content of the treated groups) or a low-fat diet (5%, w/w). There were no treatment-related differences in body weight, food intake, organ weights, haematology or clinical chemistry. Thus, this study indicates that a blend of algal and fungal oils is a safe source of DHA and ARA as it produced no adverse effects in rats when administered for 4 wk at levels up to 22 times the expected infant exposure.

Administration, Oral↗
PubMed2003

Paediatric group position statement on the use of soya protein for infants.

Breast feeding should be strongly encouraged as providing the safest, most nutritionally adequate form of feeding for most infants. Dietitians should discourage the use of soya protein in children with atopy or cow's milk allergy in the first six months of life to avoid sensitisation to soya protein and exposure to phytoestrogens while organ systems remain at their most vulnerable. This would include soy infant formula and soya products such as desserts etc. When a soy-based infant formula is used, parents should be informed of current findings relating to phytoestrogens and health and on the clinical need for soy formula. Any parent choosing to refuse soya for their infant should be supported in their decision. More research into the long-term effects of phytoestrogen exposure in infants is needed and into whether any adverse effects are dose related. This position statement will be updated as further evidence becomes available.

Breast Feeding↗
PubMed2004

Dephytinisation of soyabean protein isolate with low native phytic acid content has limited impact on mineral and trace element absorption in healthy infants.

Infant formulas based on soyabean protein isolate are often used as an alternative to cows'-based formulas. However, the presence of phytic acid in soya formulas has raised concern about the absorption of trace elements and minerals from these products. The aim of the present study was to evaluate mineral and trace element absorption from regular and dephytinised soya formula in healthy infants. Soyabean protein isolate with a relatively low native content of phytic acid was used for production of a regular soya formula (300 mg phytic acid/kg liquid formula) and an experimental formula was based on dephytinised soya protein isolate (<6 mg phytic acid/kg liquid formula). Using a crossover study design, apparent mineral and trace element absorptions were measured by a stable isotope technique based on 72 h faecal excretion of non-absorbed stable isotopes (Zn, Fe, Cu and Ca) and by the chemical balance technique (Mn, Zn, Cu and Ca) in nine infants (69-191 d old). Fe absorption was also measured by erythrocyte incorporation 14 d after intake. The results from the present study demonstrated that Zn absorption, measured by a stable isotope technique, was significantly greater after dephytinisation (mean value 16.7 v. 22.6 %; P=0.03). No other statistically significant differences between the two formulas were observed. The nutritional benefit of dephytinisation was marginal in the present study. Based on these results, the use of soyabean protein isolate with low native content of phytic acid should be promoted for production of soya formulas and adequate addition of ascorbic acid to enhance Fe absorption should be ensured in the products.

Cross-Over Studies↗
PubMed1995

Differences in morbidity between breast-fed and formula-fed infants.

To determine whether breast-feeding is protective against infection in relatively affluent populations, morbidity data were collected by weekly monitoring during the first 2 years of life from matched cohorts of infants who were either breast fed (BF) (N = 46) or formula fed (FF) (N = 41) until at least 12 months of age. Cohorts were matched for characteristics such as birth weight and parental socioeconomic status, and we controlled for use of day care in data analysis. Mean maternal educational level was high (16 years) in both groups. In the first year of life the incidence of diarrheal illness among BF infants was half that of FF infants; the percentage with any otitis media was 19% lower and with prolonged episodes (> 10 days) was 80% lower in BF compared with FF infants. There were no significant differences in rates of respiratory illness; nearly all cases were mild upper respiratory infections. Morbidity rates did not differ significantly between groups in the second year of life, but the mean duration of episodes of otitis media was longer in FF than BF infants (8.8 +/- 5.3 vs 5.9 +/- 3.5 days, respectively; p = 0.01). These results indicate that the reduction in morbidity associated with breast-feeding is of sufficient magnitude to be of public health significance.

Adult↗
PubMed2006

Differences in perception of the WHO International Code of Marketing of Breast Milk Substitutes between pediatricians and obstetricians in Japan.

BACKGROUND: The World Health Organization International Code of Marketing of Breast-Milk Substitutes (WHO Code) aims to protect and promote breastfeeding. Japan ratified the WHO Code in 1994, but most hospitals in Japan continue to receive free supplies of infant formula and distribute discharge packs to new mothers provided by infant formula companies. The aim of this study was to explore the knowledge and attitudes of pediatricians and obstetricians in Japan to the WHO Code. METHODS: A self-completion questionnaire was sent to 132 pediatricians in the 131 NICUs which belonged to the Neonatal Network of Japan, and to 96 chief obstetricians in the general hospitals in the Kanto area of Japan, in 2004. RESULTS: Responses were received from 68% of pediatricians and 64% of obstetricians. Sixty-six percent of pediatricians agreed that "Breastmilk is the best", compared to only 13% of obstetricians. Likewise, pediatricians were more likely to be familiar with the WHO Code (51%) than obstetricians (18%). CONCLUSION: In Japan, pediatricians and obstetricians, in general, have low levels of support for breastfeeding and low levels of familiarity with the WHO Code. To increase the breastfeeding rates in Japan, both pediatricians and obstetricians need increased knowledge about current infant feeding practices and increased awareness of international policies to promote breastfeeding.

Journal Article↗
PubMedDate not supplied

Growth comparison of breast-fed and formula-fed infants.

Growth during infancy was analyzed using data from a study in which groups of infants were fed breast-milk or one of three formulas: Good Start, Isomil, or Similac. After adjustments for size at birth and parental stature, growth was within the normal range for all feeding groups and there were few significant differences in growth between those fed different formulas. There was, however, some evidence that Similac was associated with larger gains in weight and that those fed breast-milk or Isomil had lower weights at ages older than two months. Additionally, at six months, recumbent length tended to be smaller in the Isomil group of boys and in both the Isomil and Similac groups of girls and larger in the Good Start groups of boys and girls.

Body Height↗
PubMed1996

Incidence of gastroesophageal reflux with whey- and casein-based formulas in infants and in children with severe neurological impairment.

Ten exclusively gastrostomy-fed, neurologically impaired children (4.5-14.5 years old) with gastroesophageal reflux were randomly assigned to receive feedings with either a casein- or a whey-based formula for 48 h each and then crossed over to the other formula. One 24-h pH probe study each was performed while being fed casein- and whey-based formula, respectively. There was a significant reduction in episodes and duration of gastroesophageal reflux while consuming the whey-based formula (p < 0.05). Whey-based feedings should be considered an additional tool in conjunction with other antireflux measures to treat gastroesophageal reflux more effectively in children with severe neurological impairment. A similar study was also conducted involving 14 infants (3-12 months old) with documented gastroesophageal reflux using 24-h pH probe monitoring while consuming a casein-based formula. The formula was changed to a whey-based formula and the pH probe study repeated within 3-5 days. Four infants showed improvement and the rest showed either deterioration (1/14) or comparable results (9/14). The reduction in the mean number of episodes or duration of gastroesophageal reflux with the whey-formula was not significantly different from that with the casein-based formula (p > 0.05). Based on these findings, generalized recommendations for the use of whey-based formula in infants with gastroesophageal reflux cannot be made.

Adolescent↗
PubMed1993

Type of milk feeding in infants and young children up to 19 months of age in three socio-economic groups in Madrid.

The feeding practices of 344 children in Madrid between 3 and 19 months were investigated by controlled interview or their mothers of care-takers. Four different types of milk were given to the children: human milk, infant formula, follow-on formula and cow's milk. Three periods could be defined when infants were most likely to change from one milk type to another. The majority of babies changed from human milk to infant formula some time in the first three months of life. At between four and six months, about half the sample changed to a follow-on formula and, finally, around the baby's first year formula was substituted for cow's milk. Differences in feeding behaviour could be observed among socio-economic groups, but were not statistically significant. Feeding patterns closely followed international recommendations for infant feeding.

Animals↗
PubMed2002

[Estimation of potentially available protein in infant starting formulas for term and preterm neonates].

Sixteen milk-based starting formulas were analyzed with the aim of calculating their "true protein" content and assessing "in vitro" protein digestibility, in order to estimate levels of potentially available protein. Ten of them were designed for term infants: 7 had a casein:whey protein ratio 40:60 (adapted formulas) and 3 a ratio 80:20 (non-adapted); the 6 remaining formulas (all adapted) were for preterm infants. Nitrogen was determined by the Kjeldahl method. True protein was calculated as (total N--non-protein N) x 6.25. NPN was determined in the soluble fraction, after protein precipitation with 24% trichloroacetic acid and centrifugation. Digestibility was assessed by digestion with pepsin and pancreatin, and defined as the increase in non-protein N after enzymatic digestion. Values for true protein were from 1.3 to 2.3 g/dL and for non protein N, from 4.5 to 13.7%. Digestibility values varied between 59.0 and 92.5%; an inverse trend was observed between protein digestibility and protein content. Considering both the "true protein" levels and their digested proportions, all preterm and 60% of the term formulas would present potentially available amounts below those recommended. These observations constitute an alert, even though this method of assessing "in vitro" protein digestibility represents only an approximation to physiological processes; however, it could be useful in order to evaluate the intensity of the heat treatments to which these formulas were subjected. On the other hand, since NPN allows the estimation of the true protein provided by the formulas, either its percentage or the true protein content could be included on the label.

Animals↗
PubMed1988

Effect of two types of hospital feeding gift packs on duration of breast-feeding among adolescent mothers.

Two hundred forty-four adolescent mothers under 18 years of age were surveyed during a 15-month period, and 53% elected to breast-feed. A subset of 60 primiparous breast-feeding adolescents were enrolled in an investigator-blind, randomized, prospective study to compare the effects on breast-feeding duration of a standard hospital discharge feeding gift pack containing formula and a specially designed study pack that was free of infant formula. Thirty-five percent of the 60 women breast-fed less than 1 month; 22% nursed longer than 1 month but less than 2 months; and 43% breast-fed more than 2 months. There was no significant difference in breast-feeding duration among mothers by gift pack group, although those who received the study gift pack rated it higher in usefulness (p less than (0.025). The provision of infant formula samples did not appear to have a deleterious effect on the duration of breast-feeding among a population of adolescent mothers.

Adolescent↗
PubMed2002

Dietary intakes of 6-24-month-old urban South Island New Zealand children in relation to biochemical iron status.

OBJECTIVE: To investigate food sources and intakes of iron, and dietary factors associated with serum ferritin levels in 6-24-month-old children. DESIGN: A cross-sectional survey employing proportionate cluster sampling was conducted in 1998/1999. Dietary intakes were assessed using a non-consecutive 3-day weighed food record. Serum ferritin and C-reactive protein were analysed from non-fasting venepuncture blood samples and general sociodemographic data were collected. SETTING: Cities of Christchurch, Dunedin and Invercargill, New Zealand. SUBJECTS: Randomly selected healthy 6-24-month-old non-breast-feeding children (n = 226). RESULTS: Total iron intakes (+/- standard deviation (SD)) among non-breast-feeding infants (< 12 months old; n = 42) and toddlers (> or = 12 months old; n = 184) were 8.4 +/- 2.9 mg day(-1) and 5.0 +/- 2.5 mg day(-1), respectively. Fifteen per cent of infants and 66% of toddlers were at risk of inadequate iron intakes. Main sources of dietary iron were infant formula (60%) for infants and cereals (31%) for toddlers. Meat contributed on average 2% and 10% of dietary iron in the infant and toddler diets, respectively. Dietary factors positively associated with serum ferritin were intakes of iron and vitamin C, whereas intakes of calcium and dietary fibre were negatively associated. For each 1% increase in percentage of energy from iron-fortified formula concomitant with a 1% decrease from dairy products, there was a 4.2% increased odds of replete iron stores (ferritin > or = 20 microg l(-1)). CONCLUSIONS: Toddlers were at higher risk of sub-optimal iron intakes than infants. Results suggest that a diet high in bioavailable iron is important for optimising the iron stores of young children in New Zealand.

Bottle Feeding↗
PubMed2002

Silicon determination in milk by electrothermal atomic absorption spectrometry using palladium as chemical modifier.

A direct method for silicon determination in milk samples by Electrothermal Atomic Absorption Spectrometry was developed. Palladium was used as chemical modifier at a concentration of 610 mg L(-1); with this modifier, silicon was stable up to 1800 degrees C. The precision and accuracy of the method were investigated. The detection limit was 16.2, 2.7 and 7.2 micro g L(-1) for cows' milk, human milk and infant formula, respectively. The method was applied to silicon determination in 17 infant formula samples, 13 human milk samples and 12 cows' milk samples.

Animals↗
PubMedDate not supplied

[Dietary chloride deficiency in premature infants?].

In recent years uncontrolled decrease of chloride contents in some charges of infant formulas has caused chloride deficiency in some infants. The chloride requirement in infants of 5.8 kg has been estimated to be 3.6 mmol/d. Accordingly, prematures of 1.3 kg would require about 2.6 mmol/d. Considering the daily intake of fluid, the minimum concentration of chloride of a formula for infants has to be 4.5 mmol/l and a formula for prematures 11.8 mmol/l. In 4 formulas for prematures and 7 humanized formulas for infants the concentration of chloride ranged from 7.1 to 15.8 mmol/l. In the FRG some prematures may have an inadequate intake of chloride.

Body Weight↗
PubMed1976

Growth of infants fed a zinc supplemented formula.

Some infant milk formulae have a lower zinc content than the original cow's milk. Zinc is a nutrient necessary for growth and, in this double-blind controlled study, the effects of supplementing Similac with iron with 4 mg/liter of zinc were determined. By 6 months of age, mean growth increments for the supplemented male infants were 2.1 cm greater in length (P less than 0.025) and 535 g greater in weight (P less than 0.05) than for male controls. Growth increments for female test and control infants did not differ significantly. Plasma zinc levels were, at 3 months of age, significantly higher for both male and female supplemented infants. By 6 months, only the male supplemented infants maintained significantly higherplasma zinc levels (P less than 0.025). The addition of zinc was associated with a lower incidence of disturbed gastrointestinal function (P less than 0.005) and not accompanied by any signs of toxicity.

Age Factors↗