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PubMed2006

Reduction of crying episodes owing to infantile colic: A randomized controlled study on the efficacy of a new infant formula.

OBJECTIVES: The aim of this study was to evaluate the efficacy on crying episodes owing to infantile colic of a new infant formula containing partially hydrolysed whey proteins, prebiotic oligosaccharides (OS), with a high beta-palmitic acid content. DESIGN: Prospective randomized controlled study. SETTING: Italy. SUBJECTS: Two hundred and sixty-seven formula-fed infants, aged less than 4 months, with infantile colic, were randomized to receive either the new infant formula (study treatment (ST)) or a standard formula and simethicone (6 mg/kg twice a day) (control treatment (CT)). A questionnaire was given to parents to evaluate for 14 days the daily number of colic episodes and crying time. RESULTS: Out of the 199 infants who completed the study, 96 were treated with the new formula and 103 were not treated. Infants receiving the new formula had a significant decrease in colic episodes after 1 week (2.47+/-1.94 at day 7 vs 5.99+/-1.84 at the study entry) compared to infants receiving the CT (3.72+/-1.98 at day 7 vs 5.41+/-1.88 at the study entry) (P < 0.0001). Also at day 14, the crying episodes were significantly different between the two groups of infants (1.76+/-1.60 in ST vs 3.32+/-2.06 in CT) (P < 0.0001). CONCLUSIONS: The use of a partially hydrolysed formula supplemented with fructo- and galacto-OS induces a reduction of crying episodes in infants with colic after 7 and 14 days when compared with a standard formula and simethicone.

Colic↗

PubMed1999

Infant formula preparation, handling, and related practices in the United States.

OBJECTIVE: To describe practices related to infant formula feeding: diluting and concentrating formula, mixing formula with warm tap water, sterilizing, storing prepared formula, heating in a microwave oven, putting the baby to bed with a bottle, and adding cereal and sweeteners to formula; to analyze characteristics related to compliance with recommended practices; and to examine the relation between formula handling and infant diarrhea. SUBJECTS/DESIGN: Subjects were mothers who fed their infants formula (more than 1,000 subjects at each infant age). Data are from the US Food and Drug Administration's Infant Feeding Practices Study (IFPS), a national longitudinal survey with a nonprobability sample. Data were collected by mail, and formula practices were included at infant ages 2, 5, and 7 months. STATISTICAL ANALYSES PERFORMED: Logistic regression was conducted and percentages and odds ratios were calculated, adjusting for instruction in preparing formula from a health care professional, education, income, age, parity, work status, and breast-feeding practices. RESULTS: Failure to comply with recommendations was high for several practices with clear health implications; 33% of mothers mixed formula with warm tap water and up to 48% heated bottles in a microwave oven. Mothers of 2-month-old infants who received instruction from a health care professional and who breast-fed showed increased compliance, but few demographic characteristics, such as education, were related. Diarrhea increased with ambient holding of formula for older infants. APPLICATION: Advice from a health care professional can improve formula-handling behaviors. Dietitians and other health care professionals should provide information on proper preparation and handling of infant formula to all infant caregivers.

Adult↗

PubMed1985

Infant formulas and gastrointestinal illness.

Infants under age one in a pediatric practice were followed prospectively, and the determinants of acute gastrointestinal illness were evaluated in case-control pairs, matched by birth month. The risk of acute gastrointestinal illness in infants receiving formula was six times greater than in infants receiving breast milk and 2.5 times greater than in infants receiving cow milk. In the second six months of life, infants on formula had 0.38 more gastrointestinal illness episodes per child than infants on cow milk. Episodes without rotavirus or bacterial agents accounted for most of the increased risk of formula. The increased risk could not be explained by iron fortification of the formulas, prescription of non-milk based formulas to high-risk infants, case ascertainment bias, control selection bias, or numerous control factors. Non-antibody anti-infection properties found in cow milk are one possible explanation for these findings.

Animals↗

PubMed1998

Effect of long-chain polyunsaturated fatty acids in infant formula on problem solving at 10 months of age.

BACKGROUND: Long-chain polyunsaturated fatty acids (LCPUFA) are important for normal visual and brain development. Although present in human milk, LCPUFA have until recently been absent from artificial formulas, and infants may have limited ability to synthesise LCPUFA. To determine the clinical significance of this relative deficiency of LCPUFA, we undertook a randomised trial of the relation between LCPUFA supplementation and infant cognitive behaviour. METHODS: 44 term infants had been randomised to a formula supplemented with LCPUFA (21) or not supplemented with LCPUFA (23), which they had taken from birth to age 4 months. Infant cognitive behaviour was assessed at 10 months of age by a means-end problem-solving test--the intentional execution of a sequence of steps to achieve a goal. The problem required three intermediate steps to achieve the final goal, uncovering and retrieving a hidden toy. FINDINGS: Infants who received LCPUFA-supplemented formula had significantly more intentional solutions than infants who received the no-LCPUFA formula (median 2.0 vs 0, p=0.021). Intention scores (median 14.0 vs 11.5 [maximum 18]) were also increased in this group (p=0.035). INTERPRETATION: These findings suggest that term infants may benefit from LCPUFA supplementation, and that the effects persist beyond the period of supplementation. Since higher problem-solving scores in infancy are related to higher childhood IQ scores, supplementation with LCPUFA may be important for the development of childhood intelligence.

Cognition↗

PubMed1994

Infant formula development: past, present and future.

Currently available infant formulas can be separated into those intended for normal term infants and those designed for infants with special needs, i.e. infants with low-birth-weight, with allergies to milk proteins, or with metabolic disorders. New formulas are developed when groups of infants with special nutritional needs are identified. A recent example is the introduction of a soy fiber-containing formula for refeeding infants after diarrhea. Existing formulas continually change with new nutritional knowledge; an example is the addition of taurine when its role is visual function became known. The composition of human milk serves as a valuable reference for improving infant formula. However, human milk contains living cells, hormones, active enzymes, immunoglobulins and components with unique molecular structures that can not be replicated in infant formula. Additionally, unlike human milk, infant formula must remain stable on the shelf for up to 36 months. These fundamental differences between human milk and infant formula often mandate differences in composition to achieve similar clinical outcomes. New formulas or changes in formulas should confer a demonstrable advantage to the infant and not be based on compositional changes alone. Before changes are made in formulations or new formulas developed, a thorough assessment of available research needs to be made and any gaps of knowledge identified. Then a research program specific for the question at hand is developed.(ABSTRACT TRUNCATED AT 250 WORDS)

Food Technology↗

PubMed1996

Infant formula, past and future: opportunities for improvement.

Infant formulas provide nutritional support to health infants that promotes growth and development equivalent to that in healthy infants fed human milk. Formula-fed infants are not as well protected against infections, and there remain infants whose health, growth, and development may not be supported optimally by either the formulas currently available or human milk. Some infants may be better supported by genetically engineered formulas that contain immunity-enhancing antibodies or antigens. Formulas that contain cytokines promoting epithelial cell growth and integrity may be protective against necrotizing enterocolitis. Formulas containing proteins with genetically excluded allergenic epitopes or formulas with tolerogenic peptides may be useful in treating allergic diseases of suppressing the development of autoimmune disorders later in life. Formulas with genetically engineered biologically active substances might increase the absorption of nutrients in infants with compromised absorption or digestion, enhance host immunity and mucosal integrity, and, potentially militate or protect against the risk of disease.

Animals↗

PubMed1988

Determination of the phospholipid content of human milk, cow's milk and various infant formulas.

The phospholipid (PL) content of human milk, cow's milk, and various infant formulas was determined by recently developed high performance liquid chromatography (6). As the examinations promised, the content of phosphatidylinositol (PI), phosphatidylethanolamine (PE), phosphatidylcholine (PC), and sphingomyelin (SP) was not changed by homogenization and pasteurization of cow's milk. Levels of phosphatidylglycerol (PG) were below the detection limit. Furthermore it has been proved that human milk and cow's milk are more or less identical in PL content. Some of the PL in human milk varies during the course of pregnancy and postpartum. PI, PC, and SP content in the prepartum mammarial secretion lies above the average content of mature human milk after delivery. Before the contractions start, all the PL examined show a more or less considerable decrease. PC drops to 30% of the value at the beginning of the examination six weeks before delivery. PG contents are very low throughout the whole period. Contrary to the others, PC content recovers three weeks after delivery, which may be the result of the endogenous surfactant replacement system. To compare PL content with human milk and cow's milk, 13 different infant formulas have been examined. There are considerable differences to be found in and among adapted milk, partially adapted milk, and special formulas. None of the PL examined could be found in all the infant formulas, where PG content was usually low, except in some Milupa formulas. PE and PI were not to be found in some special formulas. Most of the formulas contain high amounts of SP, in some cases higher than the amount of PC. To a certain extent infant formulas contain a considerably greater amount of other PL concentrations than human milk and cow's milk. In most of the formulas examined the PL content is generally so high, that it can be used as a source of PL for the newborn.

Animals↗

PubMed1998

Low biotin content of infant formulas made in Japan.

Since minor vitamins such as biotin are not yet registered as food additives in Japan, these cannot be used to supplement infant formulas or foods, despite their nutritional value. Therefore, the biotin contents of infant formulas made in Japan were determined and compared with those from the United States (US). The Japanese products were obtained from five companies, while the US products were limited to those from one company. The average content of total biotin in 11 Japanese products for nursing of normal infants (standard formulas) was 1.04 micrograms/100 kcal (0.69 microgram/100 ml), which was significantly lower than that in two US products (2.56 micrograms/100 kcal, 1.71 micrograms/100 ml). The total biotin content in 26 Japanese infant formulas specially prepared for medical treatment and prevention of disease (special formulas) was 0.45 microgram/100 kcal (0.30 microgram/100 ml) on average. This was less than a fifth of the level in the three US products (1.82 micrograms/100 kcal, 1.22 micrograms/100 ml). There was no difference in the proportion of free biotin (the percent of active biotin to total biotin) between the Japanese and US standard formulas (67.7% and 77.2%, respectively). However, in special formulas the mean proportion of the free biotin in the Japanese products (29.4%) was lower than that in the US products (71.2%). The nutrient intake of infants is limited to the maternal milk and/or infant formulas. These findings suggest that Japanese infant formulas should be appropriately improved to maintain growth and good health. Biotin should be registered as a food additive in Japan so that it can be used to fortify infant formulas.

Biotin↗

PubMed1998

Isoflavones, soy-based infant formulas, and relevance to endocrine function.

For more than 60 years, soy-based infant formulas have been fed to millions of infants worldwide and studied in controlled clinical research. These products provide essential nutrients required for normal growth and development. The safety of isoflavones in soy-based products, including infant formulas, has been questioned recently owing to reports of possible endocrine effects in animals and in cultured cells. The literature offers no evidence of endocrine effects in humans from infant consumption of modern soy-based formulas. Growth is normal and no changes in the timing of puberty or in fertility rates have been reported in humans who consumed soy formulas as infants. Consequently, soy-based infant formulas continue to be a safe, nutritionally complete feeding option for most infants.

Animals↗

PubMed2003

Randomized double-blind study of the nutritional efficacy and bifidogenicity of a new infant formula containing partially hydrolyzed protein, a high beta-palmitic acid level, and nondigestible oligosaccharides.

OBJECTIVES: The aim of this study was to evaluate the nutritional efficacy and bifidogenic characteristics of a new infant formula containing partially hydrolyzed whey protein, modified vegetable oil with a high beta-palmitic acid content, prebiotic oligosaccharides, and starch. METHODS: In a double-blind study, healthy formula-fed term infants aged younger than 2 weeks were randomized to receive either the new infant formula (NF) or a standard formula (SF) until the age of 12 weeks. Anthropometric measurements were taken at enrollment, 6 weeks, and 12 weeks. In a subsample of infants, blood samples were taken at 6 weeks and stool samples were taken at enrollment and 6 weeks. Blood samples were analyzed for biochemical measures of protein status and amino acids, and stools were analyzed for total bacteria and bifidobacteria. Mothers completed a feeding diary and questionnaire at 6 and 10 weeks. RESULTS: One hundred fifty-four infants were enrolled in the study; 102 completed the trial. The growth of infants in both formula groups was in line with published growth curves. During the first 6 weeks, NF girls gained more weight and head circumference than the SF girls. These velocity differences were not maintained throughout the 12-week study period. The NF stools had a higher proportion of bifidobacteria at 6 weeks compared with the SF stools, and they were softer. There were no clinically significant differences in the blood biochemical and amino acid values between groups. Both formulas were well tolerated by the infants. CONCLUSIONS: When compared with a standard infant formula, the new formula supported satisfactory growth, led to higher counts of bifidobacteria in the feces, produced blood bio-chemical values typical of formula-fed infants, and was well tolerated.

Amino Acids↗

PubMedDate not supplied

Liquid chromatographic analysis of vitamin K1 in milk-based infant formula with matrix solid-phase dispersion.

A liquid chromatographic method for vitamin K1 in milk-based infant formula is described. The vitamins are extracted from infant formula by matrix solid-phase dispersion and quantitated by reversed-phase chromatography with fluorescence detection. Vitamin K1 is converted to the fluorescent hydroquinone with a postcolumn zinc reductive reactor. The limit of detection is 12 pg, and the limit of quantitation is 38 pg on-column. Linear responses were obtained in the range 0.55-22.1 ng/ml (r2 = 0.9998). Recoveries of vitamin K1 from an analyte-fortified blank material for milk-based infant formula averaged 91.7% (n = 25). The method provides a rapid, specific, and easily controlled assay for vitamin K1 in fortified infant formula.

Animals↗

PubMed1998

Adhesion inhibitory activity of beta-lactoglobulin isolated from infant formulae.

Beta-lactoglobulin was isolated from infant formulae that were ultra high temperature (UHT) -treated, sterilized or spray-dried. The effect of the isolated beta-lactoglobulin on SfaII-fimbriae-mediated adhesion of Escherichia coli to human ileostomy glycoproteins was studied in vitro. Beta-lactoglobulin isolated from sterilized formulae was found to perform significantly less well than preparations from spray-dried formulae (p = 0.05). Great heterogeneity was observed in the adhesion inhibitory capacity of beta-lactoglobulin isolated from UHT-treated formulae. Therefore, no significant difference was observed between UHT-treated and sterilized formulae or spray-dried formulae (p > 0.10). It can be hypothesized that beta-lactoglobulin from spray-dried and some UHT-treated infant formulae may affect the colonization of mucous membranes by E. coli strains causing neonatal septicaemia and meningitis.

Bacterial Adhesion↗

PubMed1986

A comparative study of a premature infant formula and preterm breast milk for low birthweight infants.

Although the unique composition of preterm milk (PTM) has led to its increasing use in feeding of low birthweight (LBW) infants, controversy exists as to whether such milk adequately meets their requirements. This study compares the clinical tolerance and anthropometric, biochemical and haematological parameters of LBW infants fed exclusively with their own mother's PTM, a premature infant formula (Alprem; Nestlé Australia) and a mixture of PTM and Alprem. Of 90 enrolled LBW infants (1000-1750 g birthweight), 78 completed the feeding trial for a mean duration of 42 days. Twenty-eight babies were fed Alprem (Group A), 31 received a mixture of Alprem and PTM (Group B) and 18 received PTM (Group C). Babies in Groups A and B were smaller, less mature and more asphyxiated at birth than those in Group C. Weight gain from full enteral feeding was greater in Group A (18.1 g/kg per day) and Group B (17.6 g/kg per day) than in Group C (13.0 g/kg per day). Throughout the trial, weight gain in Groups A and B exceeded predicted intra-uterine growth rates, whereas that for Group C approximated the predicted intra-uterine growth rates. Growth rates of length and head circumference were also greatest in the Alprem-fed babies. Infants receiving PTM were supplemented with calcium, sodium, vitamins and energy, whereas the only three infants requiring mineral supplementation in the Alprem group were those receiving Frusemide therapy for chronic lung disease. lower serum concentrations of phosphorus, iron, albumin and urea, and higher zinc and alkaline phosphatase concentrations were found in infants receiving PTM (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Anthropometry↗

PubMed2003

Do thickening properties of locust bean gum affect the amount of calcium, iron and zinc available for absorption from infant formula? In vitro studies.

Locust bean gum acts as a milk thickener in infant formula because of its high apparent viscosity. The effects of such thickening agents on metabolic and physiologic responses during infancy have not been clarified sufficiently. Due to the increased volume of the digest and the bulking and trapping effects, digestion and absorption of nutrients may be influenced in presence of locust bean gum. The central question addressed in this paper is whether the thickening properties of locust bean gum affect the availability of calcium, iron, and zinc. Increasing amounts of powdered locust bean gum were homogenised with infant formula and samples were diluted to 0.14, 0.27, 0.42 and 0.71 g/100 ml. Viscosity of the samples was measured by a Carrie-Med CSL100 rheometer. Available amounts of calcium, iron, and zinc were evaluated using a continuous-flow dialysis model with preliminary digestion. Elemental contents of samples and dialysates were analysed with atomic absorption spectrometry. The first set of experiments showed that addition of locust bean gum to infant formulas increased the viscosity of the luminal contents. Correlations between the locust bean gum concentration and the viscosity of the samples before and after gastric or intestinal digestion were highly significant (0.97). In the second set of experiments, the correlations between the locust bean gum concentration and the amounts of calcium trapped by the locust bean gum fraction also showed high significance (0.93). In the third experimental design, again strong correlations were found between the viscosity of the intestinal digest and the amounts of calcium trapped by the fibre fraction (0.90). For iron and zinc, no such relationships were found. From this experimental set-up it appears that locust bean gum influences calcium availability in infant formulas by means of its physical properties to act as thickening agent, rather than its chemical ability to form complexes as demonstrated earlier with respect to iron and zinc.

Biological Availability↗

PubMed1996

Plasma amino acid concentrations in healthy, full-term infants fed hydrolysate infant formula.

The effect of feeding hydrolysate infant formula (HF) on protein and amino acid metabolism was investigated in healthy, full-term infants who were either breast-fed (BF, n = 10) or received conventional formula (CF, n = 10) or HF based on soy and beef collagen (n = 10) with equal total protein equivalent contents. There were no differences between groups for gain in weight, length, and head and chest circumferences throughout the study. Plasma concentrations of total proteins, albumin, urea nitrogen, uric acid, and creatinine as well as total amino acid and total essential amino acid concentrations did not differ at the ages of 2, 4, and 8 weeks. In contrast, significant differences were seen in concentrations of five free amino acids. Arginine concentrations were significantly higher at the age of 4 weeks in the infants fed HF than in the other groups (71 +/- 12 versus 27 +/- 6 and 30 +/- 4, mumol/L, mean +/- SEM, HF versus BF and CF, p < 0.01). Plasma histidine concentrations were also higher in infants receiving HF (4 weeks: 217 +/- 33 versus 91 +/- 18, HF versus BF, p < 0.01; 8 weeks: 218 +/- 33 versus 105 +/- 20, HF versus CF, p < 0.01). The most pronounced feeding-related differences were seen in plasma glycine concentrations (2 weeks: 653 +/- 89 versus 345 +/- 55, HF versus BF, p < 0.01; 8 weeks: 613 +/- 74 versus 385 +/- 56 and 312 +/- 46, HF versus BF and CF, p < 0.01), with the mean value exceeding the upper limit of the normal range in infants fed HF. Although the biological importance of the differences observed remains to be clarified, further investigations on amino acid metabolism are needed to establish the final nutritional safety of feeding hydrolysate infant formulae.

Amino Acids↗

PubMed2006

Cloning and sequencing of the ompA gene of Enterobacter sakazakii and development of an ompA-targeted PCR for rapid detection of Enterobacter sakazakii in infant formula.

Enterobacter sakazakii is an emerging, infant formula-borne pathogen that causes severe meningitis, meningoencephalitis, sepsis, and necrotizing enterocolitis in neonates and infants, with a high fatality rate. Traditional detection methods take up to 7 days to identify E. sakazakii. The outer membrane protein A gene (ompA), along with its flanking sequences from E. sakazakii (ATCC 51329), was cloned in the pGEM-T Easy vector and sequenced. Comparison of the nucleotide and deduced amino acid sequences of the ompA gene with other sequences available in the GenBank database revealed a high degree of homology with ompA genes of other gram-negative bacteria belonging to the Enterobacteriaceae. Based on regions of the ompA gene unique to E. sakazakii, two primers were synthesized to develop and optimize an E. sakazakii-specific PCR. The PCR amplified a 469-bp DNA product from all E. sakazakii strains tested but not from other bacteria. Experiments to determine the sensitivity of the PCR indicated that it could detect as few as 10(3) CFU/ml of E. sakazakii bacteria in infant formula directly and 10(-1) CFU/ml after an 8-h enrichment step. We conclude that this PCR, combined with enrichment culturing, has the potential to be used as a rapid tool for detecting the presence of E. sakazakii in infant formula.

Amino Acid Sequence↗

PubMed1989

Non-protein nitrogen and true protein in infant formulas.

Protein and nitrogen (N) requirements of infants and the optimum protein level of infant formulas are still under debate. Human milk (HM) N is considered adequate although 25% of the N is provided as non-protein nitrogen (NPN), half in the form of urea. Soluble N, insoluble N, NPN and urea N were determined in HM and cow's milk (CM), 5 CM-based infant formulas, 4 soy protein-based formulas (SF), and manufacturers' skim milk and whey protein sources. Total, peptide and free amino acids were also determined in all samples. Levels of NPN and urea N in formulas were highly dependent on the type of whey used, with ion-exchange whey being highest, followed by electrodialyzed and ultrafiltered whey, respectively. SF contained very little NPN with the exception of Soyalac. Consequently, true protein [(Total N-NPN) x 6.38] was lower than the reported levels in several formulas. Levels of peptide and free amino acids were also affected by the method of whey preparation. While it has been recognized that "casein-predominant" CM formulas will have different effects on metabolic indices than "whey-predominant" formulas, this study demonstrates that there are also pronounced differences among "whey-predominant" formulas.

Amino Acids↗

PubMed1995

The fatty acid composition of banked human milk and infant formulas: the choices of milk for feeding preterm infants.

The fatty acid composition of 48 samples of banked human milk for preterm infants and four standard infants formulas available in Finland were analysed by capillary gas liquid chromatography. The banked milk was collected from mothers who had given birth 0-8 weeks previously. Saturated fatty acids accounted for approximately 50% of the fatty acids in both human milk and the formulas, while the relative content of monoenoic fatty acids tended to be higher in human milk than in the formulas. The relative content of 18:2n-6 was higher in the formulas (range 14.7%-23.2%) than in human milk (median 9.1%, range 6.3%-13.4%). Fat of banked human milk contained 0.9% and 0.7% polyunsaturated fatty acids with 20 and 22 carbon atoms (LCP), respectively, which is comparable to that of fresh mature human milk. In contrast, LCP could not be detected in any of the formulas. Conclusion. Banked human milk is a good source of LCP and offers a good alternative to LCP containing formulas.

Arachidonic Acid↗