Human milk banking at Sorrento Maternity Hospital, Birmingham.
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Disinfection↗
Biomedical subjects
B A Wharton
Publications and source records attributed to B A Wharton.
Diet and faecal flora in the newborn: iron.
The faecal flora of a baby receiving a modern infant formula is substantially different from that of a breast fed baby. This difference is a little less when whey based formulas are used. The addition of bovine lactoferrin has no effect and there is some evidence that the presence of added iron in a formula moved the faecal flora further away from that of a breast fed baby. the iron content of currently used infant formulas is much higher than that of breast milk. The effect of the addition of iron to both whey and casein based formulas on the faecal flora was examined in further detail. Faecal flora were examined at 14 days of age in 33 babies receiving a whey formula fortified with iron, 29 babies receiving a whey formula without iron, 29 babies receiving a casein formula fortified with iron, and 24 babies receiving casein formula without iron. Subsequently fewer babies in each group were examined at week 7, 11, and 15. The addition of iron to both casein and whey formulas discouraged colonisation and growth of staphylococci and bacteroids but encouraged the colonisation and growth of clostridia and enterococci. The type of protein and not the iron content had more effect upon the growth of bifidobacteria; both whey formulas, fortified or not, encouraged the colonisation by bifidobacteria. If an infant formula, for use in the first few months, is to mimic the physiological effects of breast milk, there may be microbiological arguments for not fortifying it with iron. However, large empirical trials would be necessary before advocating such a policy.
Bacteria↗
Ramadan and birth weight at full term in Asian Moslem pregnant women in Birmingham.
The birth weights of 13,351 babies born at full term from 1964-84 to Asian Moslem mothers in Birmingham were analysed to see if the effect of the Ramadan fast on maternal biochemical profiles was of any clinical relevance. These were compared with two age matched control groups comprising white and non-Moslem Asian babies. Ramadan had no effect on mean birth weight at whatever stage of pregnancy it occurred. There was an increase in the prevalence of low birth weights (4.5% to 8%) among babies who were born at full term when Ramadan had occurred during the second trimester, but this was not significant. We conclude that the Ramadan fast has no effect on the birth weights of babies born at full term.
Asia↗
Diet-related reference values for plasma amino acids in newborns measured by reversed-phase HPLC.
We have measured by reversed-phase HPLC concentrations of amino acids in plasma in groups of 80 normal appropriate-weight term babies fed from birth either a casein formula (WhiteCap SMA, n = 26), a whey formula (Gold Cap SMA, n = 26), or breast milk (n = 28). They were studied from day 11 to week 15 postpartum. The trend was towards an increase in amino acid concentrations in plasma with age, more marked in formula-fed than in breast-fed infants. Reference values were derived for each group. Both formula-fed groups showed several differences from the breast-fed group. Detailed examination indicated that tyrosine, phenylalanine, and methionine concentrations were increased in the casein-fed group greater than 20% of the time, but only threonine was similarly increased in the whey-fed group. Other amino acids, different ones for each formula group, were increased less frequently. There were no consistent correlations with any aspect of infant growth. Appropriate reference values are important for interpreting amino acid concentrations in plasma from newborns and for evaluating the effects of any future dietary modifications to infant formulas. HPLC analysis provides a suitable highly sensitive method for undertaking such studies.
Amino Acids↗
Metabolic changes in Asian Muslim pregnant mothers observing the Ramadan fast in Britain.
1. Metabolic changes associated with Ramadan fasting were studied in eleven Asian pregnant mothers. This was compared with a group of control mothers undergoing a normal physiological fast. 2. At the end of the Ramadan fast day there was a significant fall in glucose, insulin, lactate and carnitine, and a rise in triglyceride, non-esterified fatty acid and 3-hydroxybutyrate. When compared with the control group, none of the Ramadan mothers had a completely normal set of biochemical values at the end of the fast day. 3. Pregnancy outcome in the two groups was comparable. 4. We are wary of the metabolic departures from normal observed in the Ramadan fasting mothers. If asked we advise mothers to take up the dispensation from fasting during pregnancy which is allowed.
Adult↗
Nonlipid formula components and fat absorption in the low-birth-weight newborn.
The relationship between nonlipid formula components and fat absorption in newborns is largely uninvestigated. Two formulas of identical fat blend but different protein quality and acid-base properties were fed to two groups of babies from birth and during 3-5 d balance periods in the third week of life. Babies receiving a formula of higher acidity containing predominantly curd protein absorbed a significantly lower percentage of their fat and nitrogen intake than babies receiving a curd-and-whey protein formula (fat absorptions of 73 +/- 11.0 and 85 +/- 8.0%, means +/- SD, p less than 0.04; N absorptions of 90 +/- 3.0 and 93 +/- 1.0%, p less than 0.03, respectively). The feces of the curd-formula babies contained a smaller proportion of long-chain, saturated fatty acids and a larger proportion of shorter-chain and unsaturated fatty acids. Fatty acid type and triglyceride structure are not the only factors influencing fat absorption in newborns. Other formula components may need modification to achieve maximum fat absorption.
Bile Acids and Salts↗
An approach to setting maxima in infant formulas.
It is clearly necessary to set upper limits for a nutrient in a formula where the nutrient can have a direct toxic effect (e.g., vitamin A) or can lead to a reduced margin of safety (e.g., high dietary renal solute load during gastroenteritis). In addition, there are plausible arguments for setting upper limits for any nutrient added during manufacture. Various expert groups have used different approaches in setting upper limits, particularly for fat and minerals. Evidence of clinical toxicity and various biochemical measurements have been commonly used to determine appropriate upper levels. Less use has been made of the empirical evidence provided by nutrient concentrations in commonly used foods, e.g., breast milk and cow's milk. Four "rules" for setting maxima are suggested: a) Use evidence of clinical toxicity or reduced margin of safety if available; b) Avoid nutrient concentrations that lead to biochemical values in body fluids or tissues very different from those seen in breast-fed babies; c) An upper limit should be set for even apparently harmless nutrients that are added during manufacture; and d) When a nutrient is added, its final concentration should not normally exceed that in breast or cow's milk, whichever is the greater. Using these "rules," suggested maxima for 33 nutrients are listed.
Female↗
Iron nutrition in childhood: the interplay of genes, development and environment.
The state of a child's iron nutrition depends on his genetic endowment, the stage of development he has reached and the environment in which he lives. Genetic disorders lead more commonly to iron overload than to deficiency. Generally interplay between genes and environment is apparently of little importance when considering iron deficiency; are we missing something? The greatest demands for iron are at the time of most rapid growth, i.e. during infancy and puberty, but during early infancy body stores can meet the demand without a need for dietary iron. Oxygen, diet and microbes are the important environmental factors related to iron nutrition. The relationship of oxygen toxicity to iron nutrition in the newborn has received only fleeting study, the availability of iron from many foods is unclear; the clinical significance of iron overload and deficiency in the evolution of an infection is also unclear despite a wealth of in vitro observation. I am not convinced that the bottle fed baby should receive iron in his diet during the first 4-6 months of life. Thereafter, while the concept of universal unselective supplementation causes some uneasiness there are considerable epidemiological arguments for fortification of food with iron.
Adolescent↗
Iron deficiency and the brain.
There is increasing evidence both from 'association' and 'intervention' studies that iron deficiency has an adverse effect on brain function in animals and children. The severity and duration of iron deficiency are important in determining the effect on development. Iron replacement therapy has immediate (within 14 days) and long-term (over 3 months) beneficial effects on behaviour and psychomotor development. The mechanisms for this probably involve a number of biochemical pathways in which iron is essential. These include mitochondrial enzymes and various neurotransmitters. Cytochrome C is reduced by iron deficiency but brain tissue is relatively spared until the deficiency is severe. Levels of neurotransmitters such as noradrenaline, serotonin and dopamine are all altered during iron deficiency and this may explain some of the behavioural and developmental changes that occur.
Brain↗
Diet and faecal flora in the newborn: breast milk and infant formula.
This study examined the faecal flora on days 4, 14, and 28 of 17 breast fed babies and 26 bottle fed babies receiving a modern infant formula based on demineralized whey. Generally among breast fed babies bifidobacteria and staphylococci were the predominant organisms, whereas in the formula fed babies the predominant organisms were enterococci, coliforms, and clostridia. Despite the extensive modification of cows' milk to make an infant formula resemble human breast milk, the results are very similar to those previously reported with unmodified cows' milk baby feeds. The exact dietary factor responsible for these microbiological differences is unclear and in succeeding papers we have looked at the effects of protein quality, in particular the content of whey proteins, casein, and lactoferrin.
Bifidobacterium↗
Diet and faecal flora in the newborn: casein and whey proteins.
Despite the extensive modifications of cows' milk to make an infant formula resemble human breast milk, we showed in a previous study that the faecal flora of breast fed babies still differs substantially from that of formula fed babies. This paper describes the effects that differences in the distribution of whey proteins and caseins exert on the faecal flora. Faecal flora was examined in 33 babies receiving a whey formula, 29 babies receiving a casein formula, and 38 breast fed babies. Subsequently fewer babies in each group were studied at weeks 7, 11, and 15. More whey fed babies were colonised with bifidobacteria at 14 days compared with the casein fed group, more casein fed babies were colonised with bacteroides (at 14 days), and more had a dominant growth of enterococci (at week 7). It seems therefore that during the first two months that the whey predominant formula induced a faecal flora generally closer to that of breast fed babies than did a casein formula.
Bifidobacterium↗
Diet and faecal flora in the newborn: lactoferrin.
The faecal flora of breast fed babies differs from that of bottle fed babies. We have shown that the use of a whey predominant formula rather than a casein predominant one induced a faecal flora generally closer to that of breast fed babies but substantial differences remained. The whey proteins of breast milk include much more lactoferrin than is found in cows' milk. Observations both in animals and in vitro suggest that lactoferrin could be responsible for some of these differences between bottle and breast fed babies. This study was designed to determine the effects on faecal flora of the addition of bovine lactoferrin to the diet of bottle fed babies while holding other qualities of their diet constant. As lactoferrin is an iron binding protein three test formulas were used: (a) no added iron and no added lactoferrin (basic), (b) no iron but added lactoferrin (L), and (c) added iron and lactoferrin (LF). The addition of lactoferrin had little effect upon the faecal microflora and did not move the pattern of the faecal flora in the direction of the breast fed baby. The addition of iron to the formula had more effect on the faecal flora than did lactoferrin. At day 4 it encouraged Escherichia coli and discouraged staphylococcal faecal colonisation. At day 14 the addition of iron to the formula discouraged bifidobacteria. The reasons why bovine lactoferrin was ineffective in vivo in this study are discussed.
Bifidobacterium↗
Mildly anaemic toddlers respond to iron.
Thirty eight children with a haemoglobin concentration of 106-110 g/l were given either oral iron (n = 17) or placebo (n = 21) for two months. The treated group achieved a significantly higher rise in haemoglobin concentration; in a quarter it was greater than 20 g/l. While those with the lower mean corpuscular volume and ferritin showed greater rises in haemoglobin these indices were of little value in predicting response in an individual child.
Administration, Oral↗
Dietary management of gastroenteritis in Britain.
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Child, Preschool↗
Impaired fat deposition in pregnancy: an indicator for nutritional intervention.
Unselective dietary supplementation of pregnant mothers can have adverse effects. It is essential to predict which mothers are nutritionally at risk and would benefit from supplementation. Preliminary studies indicated that mothers who increased their triceps skinfold by less than or equal to 20 micron during the second trimester were nutritionally at risk of having a small baby. In this study anthropometric indicators were explored in 81 Asian mothers living in Birmingham. Single (distance) measurements (eg, weight at 28 wk, etc) were not effective predictors. Changes in measurements of the arm during the second trimester were predictive, and triceps skinfold remained the most effective predictor of poor fetal growth. This measurement probably reflects the balance of energy intake minus energy expenditure during the critical second trimester when the mother would normally be laying down extra fat in anticipation of later fetal demands.
Adipose Tissue↗
Consanguinity and fetal growth in Pakistani Moslems.
There is conflicting evidence about the effect of parental consanguinity on fetal growth. Previous studies have not always allowed for other factors that are known to affect birth weight, in particular, gestational age, parity, and maternal height. We have therefore studied this question in the Pakistani Moslem population in Birmingham. Babies born to parents who were first cousins were on average 80 g lighter than those born to unrelated parents, but this difference was not significant for the size of the sample studied. Nor were there any differences in the other measurements of the babies. After expressing birth weight in terms of centiles for gestational age, sex, parity, and maternal height, however, while there was no difference in the overall distribution of centiles, there were more poorly grown babies--that is, weight below the 10th centile--in the first cousin group. We conclude that parental consanguinity is associated with an increase in the number of poorly grown babies but that the overall effect on mean birth weight is small.
Age Factors↗
Food for the weanling: the next priority in infant nutrition.
The 1970s saw a revolution in the nutritional welfare of the suckling but half way through the 1980s we have yet to achieve the same success with the weanling. In the developing world the malnutrition/diarrhoea complex is a major threat to the weanling's life. Throughout the world rickets and iron deficiency are common problems. These three, protein-energy malnutrition/diarrhoea, rickets and iron deficiency anaemia are the major nutritional problems of the weanling but there are others e.g. zinc deficiency, allergy, obesity. As the weanling crosses the bridge from suckling to schoolchild he will eat the suckling's food, specially prepared weaning foods, and eventually "sensible" family foods. Beneath this bridge we need to erect a safety net of fortified foods ensuring an adequate supply of such nutrients as iron and vitamin D.
Anemia, Hypochromic↗