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PubMed1989

Calcium, phosphorus, and magnesium: how much is too much for infant formulas?

Despite the use of metabolic balance studies and measurements of bone mineral content, it is difficult to assess the requirements of Ca and P in growing infants. From observations made forty years ago with cow's milk formulas it is obvious what is too much calcium and phosphorus in infant formulas. These observations were utilized in the development of "humanized cow's milk formulas" in the 1950s. Though the total concentrations of Ca and P have been greatly reduced in these formulas, the Ca/P ratio imbalance, compared to human milk, persists. Infants fed these formulas still receive a relative phosphorus load, and cases of neonatal tetany are still occasionally reported. Thus, formula-fed infants have higher serum P and lower serum Ca concentrations than do human milk-fed infants. Unlike Ca and P, the magnesium concentration of infant formulas is similar to that of human milk, and Mg toxicity from formulas has not been reported. Like Ca and P, however, it is difficult to determine the growing infant's requirement for magnesium. The available information does not favor either increasing or decreasing the present concentrations of Ca, P or Mg in infant formulas. The upper limit for these minerals should remain at the present concentrations: 45-50 mg/dl (65-75 mg/100 kcal) for Ca, 30-40 mg/dl (48-58 mg/100 kcal) for P and 12 mg/dl (18 mg/100 kcal) for Mg.

Calcium↗
PubMed1989

Upper limits of iron in infant formulas.

Iron-fortified infant formula is effective in preventing iron deficiency at levels of iron that are compatible with an upper limit of 3 mg/100 kcal. However, lower levels of fortification may prove to be adequate. There are theoretical concerns about the effects of high levels of dietary iron on the absorption of other trace minerals and on resistance to infection. These considerations make it desirable to determine whether lower levels of iron fortification in infant formula will be equally effective in preventing iron deficiency in infants.

Anemia, Hypochromic↗
PubMed1989

Fluoride intake in early infancy.

Current regulations concerning nutrient content of infant formulas do not specify either a lower or an upper limit for fluoride content. There would appear to be no need to specify a lower limit. An upper limit of 0.06 mg per 100 kcal is achievable and is recommended. Intake of fluoride by the infant will be influenced more by the water used as a diluent than by the concentrated liquid or powder used in formula preparation.

Energy Intake↗
PubMed1989

Upper limits of zinc, copper and manganese in infant formulas.

Upper limits are proposed for zinc, copper and manganese in infant formulas. At these limits intakes would be lower than would intakes shown to be associated with toxicity, but the upper limits of an entirely safe range of intake remain uncertain. The proposed limits provide a considerable margin beyond normal nutritional requirements, and it is not recommended that formulas should typically contain these quantities. The proposed upper limits (per 100 kcal) are 1.5 mg of zinc, 200 micrograms of copper and 50 micrograms of manganese.

Copper↗
PubMed1989

Upper limit of iodine in infant formulas.

Iodine is the rate-limiting substrate for thyroid hormone synthesis by the thyroid gland and must be available in threshold amounts to prevent goiter and hypothyroidism. Because excess iodine can inhibit thyroxine synthesis, an upper limit of iodine in infant formulas of 75 microg/100 kcal was proposed by the Food and Drug Administration in 1985. Review of recent studies of iodine physiology in infants and iodine content of milk suggests that a safe upper limit of iodine intake by normal, term infants should not exceed 100 microg/kg body wt daily. Given this limit and assuming the total intake of iodine to be derived from formula, the recommendation of 1985 still seems reasonable.

Female↗
PubMed1989

Upper limit of selenium in infant formulas.

At present, the amount of selenium in infant formulas is not controlled and varies depending upon the selenium content of the raw materials used in its manufacture. Since selenium deficiency has been associated with two diseases of childhood, prudence dictates that the concentration of selenium in infant formula be standardized. Extrapolation from studies with human adults indicates that a daily intake of 10 microg of selenium is sufficient to meet the nutritional requirement of the infant while providing a reasonable margin of safety. Extrapolation from adult studies also suggests that intakes of 75-160 microg/d might have harmful effects in infants. On the other hand, no cases of selenosis in infants have been reported in high selenium areas of the United States, where human breast milk supplies as much as 47 microg/d. Therefore, it is proposed that infant formulas contain enough selenium to provide 10-45 microg/d.

Female↗
PubMed1989

Trace element absorption in infants as a foundation to setting upper limits for trace elements in infant formulas.

The bioavailability of the trace elements iron, zinc, copper and manganese from human milk is high compared to cow's milk and infant formulas. This high bioavailability may be explained by the presence of lactoferrin in human milk, which may facilitate iron and manganese uptake via an intestinal receptor for this protein. High concentrations of ascorbate and citrate may also facilitate uptake of trace elements from human milk and milk formulas, while a high concentration of casein in cow's milk and cow's milk formulas may limit trace element absorption from these diets. Trace element absorption from soy formula is low, mostly due to the presence of phytate but possibly also due to some protein fraction. Trace elements sharing absorptive pathways compete for uptake, and imbalances in the ratios between trace elements (Fe/Zn, Zn/Cu, Fe/Mn) in formulas may impair trace element absorption. These factors need to be taken into consideration when setting upper limits for trace elements in formulas. With our present knowledge, an upper limit for iron of 14 mg/l, for zinc, 12 mg/l, copper, 1.2 mg/l, and manganese, 0.6 mg/l are suggested. The capacity of infants to homeostatically adapt to varying intakes of trace elements needs to be further evaluated.

Female↗
PubMed1990

Nutritional management and weight changes during hospitalization of Brazilian infants with diarrhoea: primary reliance on oral feeding or continuous nasogastric drip with locally made, modulated minced chicken formula.

The nutritional management of infants admitted with diarrhoea to the University Hospital of Botucatu includes a change from bolus feeding of a modulated minced-chicken formula to a continuous nasogastric drip (NGD) feeding, whenever the required calorie intake is not achieved or the diarrhoea does not subside. To evaluate this approach, the clinical course and weight changes of 63 children, aged 1-20 months, were reviewed; most (81 per cent) were below the third percentile for weight at admission and 76 per cent had a total duration of diarrhoea greater than or equal to 10 days. Associated infections, mainly systemic, were present at or after admission in 70 per cent of them. Twenty-five survivors needed nutritional support (NS), predominantly NGD, for a median duration of 30 per cent of their admission time, and were compared to 31 survivors managed without NS. Those who necessitated NS lost weight for a significantly longer median time (12 x 4 days, p less than 0.005), but their total weight loss was similar (5 x 4 per cent) as well as diarrhoea's duration (8 x 7 days). There was a tendency for a longer hospitalization (21 x 16 days 0.05 less than P less than 0.10) and a longer span to begin weight gain after diarrhoea's end for the group with NS (p less than 0.05), but subsequent growth quotient and daily weight gain during admission were similar for both groups. Both groups of survivors received similar amounts of energy, although the initial increase was delayed for those who needed the NGD.(ABSTRACT TRUNCATED AT 250 WORDS)

Brazil↗
PubMed1996

Efficacy of traditional rice-lentil-yogurt diet, lactose free milk protein-based formula and soy protein formula in management of secondary lactose intolerance with acute childhood diarrhoea.

Secondary lactose intolerance is often a cause of prolongation of diarrhoeal episodes. As appropriate management of lactose intolerance is elimination of lactose from diet, expansive lactose free formulae are often prescribed in acute childhood diarrhoea without establishing diagnosis of lactose intolerance. Since cheap weaning diets made from locally available cereals have been found effective in management of persistent diarrhoea, we postulated that same weaning diet made of rice lentil and yogurt (K-Y diet) could be effectively used in management of acute childhood diarrhoea associated with secondary lactose intolerance. We compared this K-Y diet with milk protein-based lactose free and soy-protein formula. Thirty children between 3-18 months of age completed dietary trial for 72 h. Of these nine children received K-Y diet (Group A), four children received milk protein-based formula (Group B) and 11 children received soy protein formula (Group C). Stool frequency was significantly reduced in children in Group A (13 +/- 6 on day 1 to 6 +/- 5 on day 3) and in Group B (13 +/- 5 on day 1 to 7 +/- 4 on day 3), but not in Group C (13 +/- 4 on day 1 to 10 +/- 8 on day 3). No significant difference was observed in intake of diet, total calories intake, and fluid intake among the three groups. It is concluded that cheap weaning diet made of locally available cereals and yogurt can be used effectively in management of secondary lactose intolerance associated with acute childhood diarrhoea.

Child↗
PubMed1985

Absorption of a new semielemental diet in infants with cystic fibrosis.

A new semielemental formula made up of whey protein hydrolysate, medium-chain triglyceride as 50% of fat, and glucose polymer was studied in 21 cystic fibrosis infants to determine whether its intestinal absorption was better than that of a standard milk-based formula. Each experiment lasted 10 days, during which the patient was fed for 5 days on one formula and immediately afterwards for 5 days on the alternative formula, without any pancreatic enzyme replacement. Fat and nitrogen absorption were assessed by 3-day balance studies, stool fat was assayed by a modified Van de Kamer method, and stool nitrogen by an automatic method. Ten infants with very severely impaired digestive function (coefficient of fat absorption on normal diet less than or equal to 75%) showed a highly significant improvement in fat and nitrogen absorption, leading to a significant gain in weight when fed on semielemental diet compared with standard diet. No significant improvement was observed in fat and nitrogen absorption or in weight gain in the 11 infants with less severe malabsorption (coefficient of fat absorption on normal diet greater than 75%). These results were obtained over a short period and have to be confirmed over a prolonged period of study with pancreatic enzyme supplementation. However, they suggest that such a semielemental diet should be effective for short-term treatment in selected CF infants who have difficulty in starting to thrive adequately.

Absorption↗
PubMedDate not supplied

Background levels of carbon-13 reduced in breath and stool by new infant formula.

Studies of the absorption and bioavailability of nutrients naturally enriched with 13C require accurate measurements of small increases of 13C in respiratory CO2 and stool carbon. The sensitivity of these measurements would be increased if the natural background of 13C in these excreta were reduced. We have developed a 13C-depleted infant formula based on lactose, whey, and casein from New Zealand cows that consume only C3 vegetation naturally low in 13C. This formula, designated CNRC3, was produced by a commercial infant formula manufacturer and was comparable with a 60:40 whey/casein product. To test the ability of the formula to reduce baseline levels of 13C in infant excreta, 10 formula-fed infants 28-60 days old and free of metabolic disorders were enrolled in the 9-day study. Two stool samples were collected daily. Infants received their usual formula on days 1 and 2 and were switched to CNRC3 formula for days 3-9. On days 2 and 9, seven breath samples were collected at 30-min intervals with a face mask. Breath and stool samples were analyzed for 13C content by gas isotope ratio mass spectrometry. Infants consuming their commercial formula had breath delta 13C values of -21.1 +/- 0.6% over the 3-h collection period; stool values were -22.9 +/- 0.4%. After 7 days on the CNRC3 formula, delta 13C values of breath declined by 5.6% to -26.7 +/- 0.7%; stool values declined by 3.0% to -25.6 +/- 0.5%. The reduced background of 13C achieved by the CNRC3 formula can improve resolution of excess 13C from naturally enriched substrates in infant breath by approximately 50% and in stool by approximately 30%.

Breath Tests↗
PubMed1995

Polyamine profiles in human milk, infant artificial formulas, and semi-elemental diets.

Using a sensitive high-performance liquid chromatography method, we quantified the concentration of polyamines (putrescine, spermidine, and spermine) in human milk as well as in a representative group of commonly used artificial infant formulas. Variations in polyamine levels were also analyzed in human milk during the immediate postnatal period. During the first week postpartum, putrescine levels in human milk remained very low and varied little, while spermidine and spermine concentrations rose markedly during the first 3 days, reaching plateau levels that were 12 and eight times higher, respectively, than the values measured on day 0. The mean total polyamine concentration was 557 +/- 18 nmol/dl with the following profile: spermine, 313 +/- 16; spermidine, 220 +/- 20; and putrescine, 24 +/- 3.5. In artificial powdered formulas, the polyamine concentration was approximately 10 times lower than in human milk, with no difference in putrescine and spermine contents between first-age and second-age formulas. By contrast, semi-elemental diets prepared by hydrolytic procedures using crude extracts of pancreatic enzymes were shown to be major sources of polyamines with a profile similar to that of human milk. Compared with first-age formulas, mean concentrations in spermine and spermidine were 39 and six times higher, respectively, in these semi-elemental diets, whereas putrescine levels remained almost equivalent in all types of milk tested. These data indicate that human milk and some semi-elemental diets provide substantial amounts of spermine and spermidine to neonates and infants that could potentially modulate intestinal maturation.

Chromatography, High Pressure Liquid↗
PubMedDate not supplied

Plasma transferrin receptor levels and indices of erythropoiesis and iron status in healthy term infants.

PURPOSE: The goal of this study was to determine if the postnatal changes in plasma transferrin receptor (TfR) levels in healthy infants were associated with changes in erythropoiesis or iron status. SUBJECTS AND METHODS: Longitudinal blood samples were obtained monthly from healthy term infants fed iron-fortified formula for the first 7 months and analyzed for plasma TfR and indices of erythropoiesis and iron status. RESULTS: Plasma TfR level rose during the first 2 months of life (p < 0.002). When examined for its association with indices of erythropoiesis, plasma TfR was negatively associated with hemoglobin (Hb) (p < 0.01), and positively associated with plasma erythropoietin (EPO) concentration (p < 0.005) and absolute reticulocyte count (p < 0.005). Plasma TfR was not associated with erythrocyte protoporphyrin. Although indices of iron status were not suggestive of iron deficiency, plasma TfR was negatively associated with plasma ferritin, Tf saturation, and plasma iron, and positively associated with total iron binding capacity (TIBC) (p < 0.0001 for all). CONCLUSIONS: Increases in plasma TfR levels were observed during normal infancy. The increases in plasma TfR levels correlate with increases in erythropoiesis without evidence for functional iron deficiency.

Birth Weight↗
PubMed1998

Effectiveness of a home-made meat based formula (the Rezza-Cardi diet) as a diagnostic tool in children with food-induced atopic dermatitis.

The aim of this study was to investigate the effectiveness of a home-made meat based formula (the Rezza-Cardi diet), as a diagnostic tool for children with atopic dermatitis and suspected multiple food hypersensitivity. Severity scores for atopic dermatitis, body weight and serum lipid profile were evaluated at baseline and four weeks following the feeding with the home-made meat based formula in 16 children with atopic dermatitis and suspected multiple food hypersensitivity. The severity score of the skin lesions improved considerably in all the children; no significant difference was observed in the serum lipid levels before and after one month following the feeding with the home-made meat based formula. All children gained weight according to the Italian Standards. The results of this study indicate that the home-made meat based formula is a useful elimination diet in children with atopic dermatitis and suspected multiple food hypersensitivity.

Child, Preschool↗