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An evaluation with piglets of bovine milk, hydrolyzed bovine milk, and isolated soybean proteins included in infant milk formulas. II. Stomach-emptying rate and the postprandial change in gastric pH and milk-clotting enzyme activity.

The piglet was used as a model for the human infant to determine the effect of the protein source of a milk formula on stomach-emptying rate and the postprandial changes in gastric pH and milk-clotting enzyme activity. Three liquid milk formulas containing either intact bovine milk protein, hydrolyzed bovine milk protein, or isolated soybean protein as the sole source of dietary protein were given to five 37-day-old piglets that had undergone surgery for the preparation of a simple gastric fistula. At set times after commencement of a meal, the stomach contents were removed via a gastric cannula and weighed; then pH and milk-clotting enzyme activity were determined. The isolated soybean protein-based formula tended to empty from the stomach more slowly than did the bovine milk-based formulas. Maximum difference (p less than 0.05) was found at 3 h postfeeding, where 30% of the ingested soybean formula dry matter remained in the stomach; comparable values for the intact bovine milk-based formula and hydrolysate were 22 and 12%, respectively. The type of protein did not significantly (p greater than 0.05) affect the postprandial change in gastric pH or gastric milk-clotting enzyme activity. Gastric pH increased sharply after feeding, from pH 1.5 at 0 h to pH 5.2 at 1 h, and then fell gradually over the following 4 h to pH 1.84.

Analysis of Variance↗

Soy-based formulas and phyto-oestrogens: a safety profile.

Phyto-oestrogens are non-steroidal plant-derived compounds that possess oestrogenic activity and act as selective oestrogen receptor modulators (SERMs). Among the dietary oestrogens, the isoflavone class enjoy a wide-spread distribution in most of the members of the Leguminosae family, including such prominent high-content representatives as soybean. Phyto-oestrogen research has grown rapidly in recent years owing to epidemiological studies suggesting that diets rich in soy may be associated with potential health benefits. There is a paucity of data on endocrine effects of soy phytochemicals during infancy, the most sensitive period of life for the induction of toxicity. The safety of isoflavones in infant formulas has been questioned recently owing to reports of possible hormonal effects. Infants fed soy formula receive high levels of phyto-oestrogens in the form of isoflavones (genistein, daidzein and their glycosides). To date, no adverse effects of short- or long-term use of soy proteins have been observed in humans and exposure to soy-based infant formulas does not appear to lead to different reproductive outcomes than exposure to cow milk formulas. Soy formula seems to be a safe feeding option for most infants. Nevertheless, much closer studies in experimental animals and human populations exposed to phyto-oestrogen-containing products, and particularly soy-based infant formulas, are necessary.

Humans↗

Essential fat requirements of preterm infants.

The interest in factors that modify early infant development has led investigators to focus on n-3 and n-6 long-chain polyunsaturated fatty acids (LCPUFAs) in the past 2 decades. The presence of docosahexaenoic acid (DHA) and arachidonic acid (AA) in breast milk, compared with their absence from infant formulas available in the United States, has prompted clinical trials designed to examine whether LCPUFA enrichment of infant formula has beneficial effects on maturational events of the visual system. These trials have shown significant functional advantages of LCPUFA supplementation for preterm infants, whereas benefits for full-term infants remain controversial. The growth and safety of preterm infants was not compromised by LCPUFA enrichment, although these issues remain to be resolved in clinical trials with full-term infants.

Adult↗

Hyponatremia in the very young chronic peritoneal dialysis patient.

Two anuric infants had recurrent hyponatremia during chronic peritoneal dialysis (PD). This occurred because at normal serum sodium concentrations ([Na]), Na losses from ultrafiltration (UF) were greater than the Na ingested from infant formula. Hyponatremia was corrected with increased oral Na intake or with increased dialysis solution [Na]. Anuric infants undergoing PD have hyponatremia because of their high UF requirements/body weight and the low Na content of proprietary infant formulas.

Body Weight↗

Phytic acid degradation as a means of improving iron absorption.

Phytic acid is a potent inhibitor of native and fortification iron absorption and low absorption of iron from cereal- and/or legume-based complementary foods is a major factor in the etiology of iron deficiency in infants. Dephytinization of complementary foods or soy-based infant formulas is technically possible but, as phytic acid is strongly inhibitory at low concentrations, complete enzymatic degradation is recommended. If this is not possible, the phytic acid to iron molar ratio should be decreased to below 1:1 and preferably below 0.4:1. Complete dephytinization of cereal- and legume-based complementary foods has been shown to increase the percentage of iron absorption by as much as 12-fold (0.99% to 11.54%) in a single-meal study when the foods were reconstituted with water. The addition of milk, however, inhibits iron absorption and overcomes the enhancing effect of phytic acid degradation. Dephytinization can therefore be strongly recommended only for cereal/legume mixtures reconstituted with water, especially low-cost complementary foods destined for infants in developing countries. In countries where infant cereals are consumed with milk, ascorbic acid addition can more easily be used to overcome the negative effect of phytic acid on iron absorption. Similarly with soy-based infant formulas, especially if manufactured from low-phytate isolates, ascorbic acid can be used to ensure adequate iron absorption.

6-Phytase↗

The facts about the phthalates scare.

Phthalates are a group of chemicals used in industry and present in the environment. The MAFF survey of phthalates found very low levels in all the 15 infant formula brands tested, as well as in the food chain generally. The levels of individual phthalates in formulae are low and the Department of Health has advised there is no health risk to infants. This has been confirmed by the European Commission (EC). Phthalates are fat-soluble and liable to occur in foods such as milk, cheese, meat, fish and eggs as well as infant formulae. Phthalates may also occur in breast milk. The EC has called for more research on phthalates in food and the environment.

Environmental Exposure↗

Peptide molecular lock-engineered nanobodies enable an oriented dual-modal immunoassay for reliable detection of Cronobacter sakazakii.

Conventional nanobody ELISAs for trace Cronobacter sakazakii in powdered infant formula suffer from random orientation and low signal output. We developed an oriented dual-modal immunoassay that combines site-specific biotinylation via a C-terminal AviTag and a peptide molecular lock, enabling controlled surface orientation while preserving nanobody structural integrity. This strategy was further integrated with phage-displayed nanobodies for multivalent amplification and both fluorescent and colorimetric readouts. The assay exhibited a broad linear range of 103-106 CFU/mL, with limits of detection (LODs) of 6.70 × 102 CFU/mL for fluorescence and 1.55 × 103 CFU/mL for colorimetry, showing improved sensitivity compared with the conventional passive adsorption-based Nb-ELISA evaluated in this study. XGBoost-based multimodal fusion improved quantitative accuracy, and SHAP analysis elucidated modality contributions. In spiked powdered infant formula samples, recoveries ranged from 92.1% to 118% with coefficients of variation below 5.98%, confirming acceptable matrix tolerance and analytical reliability.

Cronobacter sakazakii↗

Nonvitamin micronutrients.

Nonvitamin micronutrients encompass innumerable nutritionally active substances present in foods at low levels that may have beneficial and protective properties. These include nonvitamin carotenoids, essential fatty acids, amino acids, phospholipid components, and conditionally essential components such as carnitine, choline, inositol, and any compounds with antioxidant, growth promoting, antimicrobial, or immune potential. These analytes are grossly underrepresented in the Official Methods of Analysis (OMA). The General Referee urges that the nonvitamin micronutrients, carnitine, inositol, and nucleotides need to be strategically targeted for collaborative study because they are not covered in OMA by any technique. Carnitine is available through limited de novo synthesis, although deficiency is recognized, particularly in infants. Thus, infant formulas are commonly supplemented with carnitine, and reliable analytical techniques are needed. A published enzymatic methodology will hopefully be subjected to collaborative study in the near future. Similarly, inositol is considered a conditionally essential pseudovitamin and although microbiological, gas and liquid chromatographic techniques are generally used, these approaches have not been subjected to the highest level of validation. Nucleotides play important roles in major biochemical functions, and recent evidence suggests that dietary nucleotides are semiessential for newborns. The nucleotides and nucleosides are present in human milk at relatively high levels, so bovine milk-based infant formulas are increasingly supplemented with the 5'monophosphate nucleotides, and it is unfortunate that no current AOAC method exists for quantification of nucleotides. Colostral immunoglobulins, specifically IgG, confer passive immunity to the neonate until the immune system is developed. There has been an increase in the global availability of colostrum-based functional foods and supplements, which are claimed to improve gastrointestinal health and stimulate the immune system. In the absence of a reference analytical method, it is becoming increasingly important to standardize analysis techniques for IgG in such materials. Although commercial radial immunodiffusion (RID) kits are available, they are generally variable in response. An affinity high-performance liquid chromatography (HPLC) method based on specific binding of bovine IgG with immobilized Protein G has been validated within the laboratory of the prospective Study Director Don Otter and is currently at the protocol development stage. Biosensor technology can provide an alternative approach to IgG analysis, and an antibody-based optical method is also slated for collaborative study under Study Director Leyton Gapper. Where other organizations involved with method validation are active in these analyte areas, it may be timely to consider AOAC policy regarding joint adoption in order to avoid duplication of scarce scientific resources. Major difficulties may occur when validation protocols do not entirely meet the AOAC INTERNATIONAL, ISO 5725, and IUPAC harmonized protocols. Whether such studies need either to be repeated in full using OMA protocol, or perhaps, preferably, publish the method within OMA at a lower level of validation, requires clarification at the Official Methods Board level.

Animals↗

Diet and faecal flora in the newborn: nucleotides.

Breast milk contains nucleotide salts that are only present in minimal amounts in modern infant formulas prepared from cows' milk. Nucleotides have been suggested as cofactors for the growth of bifidobacteria in vitro. Bifidobacteria are found to be more numerous in the faeces of breast fed babies compared with those of formula fed babies. Faecal flora were examined at 2 weeks of age in 32 babies who from birth had been fed a whey based formula supplemented with nucleotide monophosphate salts, 33 babies fed an unsupplemented formula, and 21 breast fed babies. Faecal flora were also examined at 4 weeks, and 7 weeks but with fewer babies in each group. Most differences were found at 2 weeks of age when more babies fed the nucleotide supplemented formula were colonised with Escherichia coli and more had E coli as the dominant organism in their faecal flora. Fewer of these babies were colonised with bifidobacteria. The counts of bifidobacteria and enterococci were reduced in the nucleotide supplemented group but bacteroides accounted for a higher percentage of the total flora in this group of babies. Supplementation of a formula with nucleotide salts did not make the faecal flora closer to that of breast fed infants as the growth of bifidobacteria was discouraged. While there may be arguments to support the addition of nucleotides to infant formula the results of this study do not support their addition for the enhancement of bifidobacteria in the faecal flora.

Bifidobacterium↗

Feeding preterm infants after hospital discharge: effect of diet on body composition.

Our purpose in this study was to examine whole body composition, using dual energy x-ray absorptiometry (DEXA) during dietary intervention in preterm infants (< or = 1750 g birthweight, < or = 34 wk gestation). At discharge, infants were randomized to be fed either a preterm infant formula (discharge-6 mo; group A) or a term formula (discharge-6 mo; group B), or the preterm formula (discharge-term) and the term formula (term-6 mo; group C). Nutrient intake was measured between each clinic visit. To measure body composition, DEXA was used at discharge, term, 12 wk, 6 mo, and 12 mo corrected age. The data were analyzed by ANOVA. At discharge, no differences were noted in patient characteristics between groups A, B, and C. Although energy intakes were similar, protein and mineral intakes differed between groups (A > C > B; p < 0.0001). During the study, weight gain and LM gain were greater in group A than B. At 12 mo, weight, LM, FM, and BMM but not % FM or BMD were greater in group A than B. However, the effects of diet were confined to boys, with no lasting effects seen in girls. In summary, therefore, DEXA was precise enough to detect differences in whole body composition during dietary intervention. Increased weight gain primarily reflected an increase in LM and is consistent with the idea that the preterm formula more closely met protein and/or protein-energy needs in rapidly growing preterm male infants.

Absorptiometry, Photon↗

Fortifying fresh human milk with commercial powdered human milk fortifiers does not affect bacterial growth during 6 hours at room temperature.

OBJECTIVE: To evaluate the growth of resident aerobic mesophilic flora and added Enterobacter sakazakii in fresh, unfortified human milk; fresh human milk fortified with two commercial powdered fortifiers differing in iron content; and infant formula prepared from powder. SUBJECTS: Eight mothers provided preterm breast milk samples. METHODS: Breast milk samples were divided into three aliquots: unfortified, fortified with fortifier containing 1.44 mg iron/14 kcal, and fortified with fortifier containing 0.4 mg iron/14 kcal. Aliquots of formula were prepared. Breast milk and formula aliquots were divided into two test samples. Half were inoculated with low amounts of E sakazakii; half were not. All test samples were maintained at room temperature (22 degrees C), serially diluted, and plated onto agars after 0, 2, 4, and 6 hours. Plates were incubated at 35 degrees C and enumerated. STATISTICAL ANALYSES: Data were analyzed using repeated measures analysis of variance. P<.05 was considered significant. RESULTS: There were no differences in colony counts of aerobic bacteria among uninoculated or among inoculated human milk samples at any time; counts did not increase significantly over 6 hours. There were no differences in colony counts of E sakazakii among inoculated human milk samples at any time; counts did not increase significantly over 6 hours. Aerobic bacteria and E sakazakii colony counts from infant formula did not increase significantly over 6 hours. CONCLUSIONS: During 6 hours at 22 degrees C, fresh human milk and formula had negligible bacterial growth; fortifying human milk with powdered fortifiers did not affect bacterial growth.

Analysis of Variance↗

Effect of feeding whey hydrolysate, soy and conventional cow milk formulas on incidence of atopic disease in high risk infants.

The effect of feeding different infant formulas on incidence of atopic disease was assessed in a prospective double-blind randomized controlled trial among "high risk" infants with family history of atopy among first-degree relatives. The incidence of atopic eczema, wheezing, rhinitis, gastrointestinal symptoms, and colic was noted and serum IgE antibodies to milk were estimated. Seventy-two infants were recruited into each of the following groups: cow milk whey hydrolysate formula (NAN/HA), conventional cow milk formula (Similac), soy-based formula (Isomil), and exclusive breast feeding for greater than or equal to 4 months. The number of infants who exited for reasons other than atopy and were excluded from analysis were 4, 5, 4, and 12 in the four groups, respectively. The incidence of one or more symptoms of possible allergic etiology was five of 68 infants fed NAN/HA, 24 of 67 infants fed Similac, 25 of 68 infants fed Isomil, and 12 of 60 breast-fed infants. Among symptomatic infants, skin prick test to milk proteins was positive in four out of five infants fed NAN/HA, 16 of 24 fed Similac, 2 of 25 fed Isomil, and 7 of 12 breast-fed. IgE antibodies to milk were found in 2 of 68, 9 of 67, 0 of 68, and 6 of 60 infants in the four groups, respectively. It is concluded that exclusive breast feeding for more than 4 months is partially protective against the development of atopic disease among high risk infants.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

Attachment of and biofilm formation by Enterobacter sakazakii on stainless steel and enteral feeding tubes.

Enterobacter sakazakii has been reported to form biofilms, but environmental conditions affecting attachment to and biofilm formation on abiotic surfaces have not been described. We did a study to determine the effects of temperature and nutrient availability on attachment and biofilm formation by E. sakazakii on stainless steel and enteral feeding tubes. Five strains grown to stationary phase in tryptic soy broth (TSB), infant formula broth (IFB), or lettuce juice broth (LJB) at 12 and 25 degrees C were examined for the extent to which they attach to these materials. Higher populations attached at 25 degrees C than at 12 degrees C. Stainless steel coupons and enteral feeding tubes were immersed for 24 h at 4 degrees C in phosphate-buffered saline suspensions (7 log CFU/ml) to facilitate the attachment of 5.33 to 5.51 and 5.03 to 5.12 log CFU/cm(2), respectively, before they were immersed in TSB, IFB, or LJB, followed by incubation at 12 or 25 degrees C for up to 10 days. Biofilms were not produced at 12 degrees C. The number of cells of test strains increased by 1.42 to 1.67 log CFU/cm(2) and 1.16 to 1.31 log CFU/cm(2) in biofilms formed on stainless steel and feeding tubes, respectively, immersed in IFB at 25 degrees C; biofilms were not formed on TSB and LJB at 25 degrees C, indicating that nutrient availability plays a major role in processes leading to biofilm formation on the surfaces of these inert materials. These observations emphasize the importance of temperature control in reconstituted infant formula preparation and storage areas in preventing attachment and biofilm formation by E. sakazakii.

Bacterial Adhesion↗

Nutritional balance studies of VLBW infants fed their mothers' milk fortified with a liquid human milk fortifier.

This article reports the results of a study designed to compare human milk fortified with a liquid human milk fortifier to a preterm infant formula by analyzing the metabolic balances of certain nutrients when these milks are fed to premature infants. Ten very low birth weight (VLBW) infants were studied during 4-day equilibration periods, then 4-day metabolic balances of N, fat, Ca and P, while each consumed a 1:1 mixture of a pool of its own mother's milk and the liquid human milk fortifier (HM/LF). For comparison, another 10 VLBW infants were studied in similar fashion while consuming the preterm infant formula (PF). Percent nitrogen retentions were 77 +/- 4% (+SD) and 79 +/- 4%, and fat absorptions were 94 +/- 7% and 92 +/- 5% in the HM/LF and PF groups, respectively, and did not differ between the groups. Calcium retention was 86 +/- 21 mg/kg/day (51 +/- 12%) in the HM/LF group and 104 +/- 43 mg/kg/day (45 +/- 19%) in the PF group. The percent Ca retentions did not differ. Phosphorus retentions were 56 +/- 7 mg/kg/day (67 +/- 9%) and 77 +/- 18 mg/kg/day (61 +/- 14%) in the HM/LF and PF groups, respectively. Increases in weight, length, and occipitofrontal circumference (OFC) were similar and normal in both groups. We conclude that VLBW infants fed the HM/LF, mixed 1:1 with their mothers' milk, had rates of absorption and retention of Ca, P, N, and fat similar to rates found in the concurrent study of VLBW infants fed a commercially available PF.

Food, Fortified↗

Fat intake and metabolism in Swedish and Italian infants.

The purpose of the study was to compare fat intake and metabolism between two infant populations from Sweden and Italy given breast milk or similar infant formulas, but different weaning foods. Nutrient intake and fat metabolism were studied prospectively from 3-12 mo in 68 Swedish and 46 Italian healthy infants, breastfed or given similar infant formulas in combination with Swedish or Mediterranean weaning foods. Although nutrient intake and fat metabolism were similar at 6 mo, fat intake was lower at 12 mo in the Italian than in the Swedish formula group (p < 0.001). At 6 and 12 mo, higher dietary ratios of monounsaturated to saturated fatty acids (p < 0.01 and p < 0.001, respectively), and monounsaturated to polyunsaturated fatty acids (p < 0.05, p < 0.001) were found in the Italian than in the Swedish formula group. Total cholesterol and apolipoprotein B were lower at 6 mo (p < 0.01) in Italian breastfed infants than in Swedish ones. Lower concentrations at 6 and 12 mo of total cholesterol (p < 0.05, p < 0.05, respectively), apolipoprotein B (p < 0.05, p < 0.01) and triglycerides (p < 0.001, p < 0.01), and of apolipoprotein A1 (p < 0.01) at 12 mo, were found in the Italian formula group than in the Swedish one. In conclusion, plasma total cholesterol, apolipoprotein B and triglycerides were found to be lower in Italian infants than in Swedish infants during the second half of infancy. These findings may partly result from differences in fat compositions between Swedish and Mediterranean weaning diets and in total fat intake in late infancy. Differences in duration of breastfeeding and possibly in breast milk composition may also have influenced our results.

Age Factors↗