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Metabolic alkalosis due to the use of an oligoantigenic diet in infancy.

A 7-month-old boy on an oligoantigenic diet because of multiple food intolerances presented with anorexia, failure to gain weight and severe hypochloremic metabolic alkalosis with hyperreninemia. Clinical symptoms and biochemical abnormalities disappeared after adequate dietary supplementation with potassium and sodium chloride. This case emphasizes that minimal daily mineral requirements must be provided in infant diets, and highlights the risk of nutritional deficiencies inherent in the prolonged use of oligoantigenic diets not adequately supplemented.

Alkalosis↗

The influence of feeding regimens on endogenous digoxin-like immunoreactive substance concentrations in infants.

The aim of this study was to investigate serum digoxin-like immunoreactive substance (DLIS) levels in 60 healthy term infants when they reached 1-6 months of age with regard to feeding regimen. Group I consisted of 30 infants fed exclusively on breast milk. Groups II and III each consisted of 15 infants fed on formula and cow's milk, and on formula and cow's milk supplemented by breast milk, respectively. Mean serum DLIS concentrations were 0.03 +/- 0.05, 0.18 +/- 0.09 and 0.15 +/- 0.09 ng/ml in groups I-III, respectively. The difference between the DLIS levels in groups II and III was not significant. Serum DLIS levels of infants in groups II and III, on the other hand, were significantly higher than in group I (p < 0.05). These findings were interpreted to suggest that artificial nutrients may cause volume expansion and an increase in endogenous DLIS levels. The latter response is possibly a protective mechanism to decrease volume expansion in groups II and III.

Blood Volume↗

Study of adhesion and survival of lactobacilli and bifidobacteria on table olives with the aim of formulating a new probiotic food.

With the aim of developing new functional foods, a traditional product, the table olive, was used as a vehicle for incorporating probiotic bacterial species. Survival on table olives of Lactobacillus rhamnosus (three strains), Lactobacillus paracasei (two strains), Bifidobacterium bifidum (one strain), and Bifidobacterium longum (one strain) at room temperature was investigated. The results obtained using a selected olive sample demonstrated that bifidobacteria and one strain of L. rhamnosus (Lactobacillus GG) showed a good survival rate, with a recovery of about 10(6) CFU g(-1) after 30 days. The Lactobacillus GG population remained unvaried until the end of the experiment, while a slight decline (to about 10(5) CFU g(-1)) was observed for bifidobacteria. High viability, with more than 10(7) CFU g(-1), was observed throughout the 3-month experiment for L. paracasei IMPC2.1. This strain, selected for its potential probiotic characteristics and for its lengthy survival on olives, was used to validate table olives as a carrier for transporting bacterial cells into the human gastrointestinal tract. L. paracasei IMPC2.1 was recovered from fecal samples in four out of five volunteers fed 10 to 15 olives per day carrying about 10(9) to 10(10) viable cells for 10 days.

Adult↗

Randomised trial of nutrition for preterm infants after discharge.

In a randomised double blind trial, the effect on growth and clinical status of a nutrient enriched 'post-discharge' milk formula versus a standard term formula, was compared in 32 exclusively bottle fed preterm infants. The formulas were used as the sole milk intake up to a postnatal age of 9 months. Significant increases in linear growth and weight gain were observed in the infants who received the enriched diet. There were no differences in vomiting, posseting, or bowel habit between the groups. Formula volumes ingested were similar between diet groups, indicating that the difference in formula composition did not affect the infants' regulation of intake. These preliminary data suggest that there is a role for specially designed formulas for preterm infants after discharge from hospital.

Animals↗

Preparations used for the artificial feeding of infants.

Cow's milk differs from human milk in a number of important ways, and manufactures of dried milk preparations for infants have used various methods to make the composition of the diluted product more like that of human milk. The first was to add lactose, or to recommend the mother to add sucrose. This not only increased the carbohydrate, but also 'diluted' the protein and inorganic constituents which are more concentrated in cow's than in human milk. The second was to replace all or part of the cow's milk fat with animal and vegetable fats, and so make the fatty acid composition more like that of human milk fat. In particular the proportion of linoleic acid was increased and that of stearic acid decreased, and this made the fat more easily digested and absorbed by the young infant. The third modification of cow's milk has been more fundamental. Its aim has been to make a product containing less sodium and phosphorus than cow's milk and with a higher lactalbumin: casein ratio. Whey, which contains lactalbumin but not casein, is used as the starting material. This is dialysed to remove soluble inorganic constituents. Some skimmed milk is then added to supply casein and some minerals, and the composition is adjusted as required with further minerals and vitamins. Lactose is added and a mixture of animal and vegetable fats. Dried milks on sale in Britain contain added vitamins A,D, and C and also iron. Some have added copper and zinc.

Animals↗

Unconjugated and conjugated bilirubin pigments during perinatal development. IV. The influence of breast-feeding on neonatal hyperbilirubinemia.

One thousand four hundred and fifty-four consecutive full-term neonates, delivered over a period extending from February 1, 1991 to January 31, 1992 were prospectively studied during the first days of life to determine if breast-feeding and hyperbilirubinemia were related. Six hundred and five infants were exclusively breast-fed on demand, 623 received both breast- and formula-feeding, and 226 were exclusively formula-fed. Of the 1,454 newborns studied, 70 (4.8%) presented with a bilirubin serum concentration > 12.9 mg/dl (4.62% in the breast-fed group, 5.45% in the group fed with mother's milk with supplements, and 3.54% in the artificial formula group; the differences were not significant). Percent mean weight losses on the 3rd and 5th days were not significantly different. Babies breast-fed on demand seem to have a low incidence of hyperbilirubinemia similar to that found in formula-fed neonates.

Bilirubin↗

Treatment of phenylketonuria with a formula consisting of low-phenylalanine peptide. A collaborative study.

A method of preparation of a more palatable therapeutic formula for phenylketonuria (PKU), consisting of low-phenylalanine peptide (LPP), was reported. There were no adverse effects and, in fact, there was a reduced frequency of diarrhea in patients who received LPP formula for more than 6 months. The LPP formula can be used not only as a more palatable therapeutic milk for PKU, but also as an ingredient to make more palatable foods of low-phenylalanine content.

Adolescent↗

The taurine content of common foodstuffs.

There is growing evidence that taurine is a biologically valuable nutrient. However, there are few published data concerning the taurine content of different foods. We measured the taurine content of 29 meats, including both cooked and uncooked samples, nine dairy products, 17 infant or adult-feeding solutions and 48 plant foods (including vegetables, nuts or seeds, fruits and legumes. Taurine was detected in meats, dairy products, and infant feeding solutions but not in plant products or adult feeding solutions. Using these data, we compared calculated and measured daily taurine intakes in six defined diets. We present sample daily diets for omnivores, lacto-ovovegetarians and vegans (strict vegetarians), together with calculated taurine intakes.

Adult↗

Three-in-one parenteral nutrition: a safe and economical method of nutritional support for infants.

The medical records of 20 infants under 1 year of age who received parenteral nutrition (PN) for a minimum of 1 week were reviewed. Patients were divided into two groups based on the method of PN administration. One group received PN by the traditional two-plus-one method where lipid emulsion is given separately from the dextrose-amino acid mixture. The second group received PN by the three-in-one method where lipid emulsion is admixed with the dextrose and amino acids. There were no statistically significant differences between the two groups in the amount of calories, lipid, dextrose, protein, calcium, and phosphorus received per kg of body weight. Average daily weight gain was not statistically different, and no obvious trends were noted in serum biochemical parameters between the two groups. Average total PN days for the groups (13 +/- 7 days for the two-plus-one group vs 39 +/- 35 days for the three-in-one group) were significantly different (p less than 0.05). A cost comparison of the two methods of PN administration indicated that the two-plus-one method costs our hospital $11.78 more per day than the three-in-one solution. We conclude that the three-in-one method of PN administration is safe, efficacious, and cost effective for infants under 1 year of age.

Cost-Benefit Analysis↗

Taurine and cholesterol supplementation in the term infant: responses of growth and metabolism.

The effects of taurine and of cholesterol supplementation to a whey-protein-predominant formula fed ad libitum on the growth and biochemical responses of term infants were studied. The responses of these infants were compared to those of infants fed formula without a supplement and infants that were breastfed. These infants were followed for 12 weeks. No effect of cholesterol was observed on any of the measurements and no effect of taurine was observed on any of the biochemical measures with the exception that taurine concentrations in plasma and urine (reduced in infants fed formula alone) were corrected to concentrations observed in breastfed infants. Taurine supplementation had no effect on the rate of weight gain or on linear growth over the complete course of the study. Thus, taurine supplementation of formulas returns plasma and urine concentrations of this amino acid to those found in human milk-fed infants. However, these data indicate that the supplementation of formulas with taurine has no benefit with respect to growth.

Body Weight↗

The use of modular nutrients in pediatrics.

BACKGROUND: Nutrient modules are commonly used by pediatricians and dietitians. There is no readily available current literature to which those using nutrient modules can refer. Therefore, we review nutrient module composition, module use in pediatrics, and complications associated with the use of nutrient modules. METHODS: Using an online database, Meduline, we searched the literature from 1996 through 1995. RESULTS: Nutrient modules are single or multiple nutrients that can be combined with a diet to add nutrients or to change the composition of the diet. These nutrients exist as a food or as medically compounded elements of a diet but alone are not complete foods. DISCUSSION: The addition of modules to a diet can alter the composition of a diet so that a single nutrient may become deficient and the diet cannot support normal growth and development. With use of nutrient modules, diets can be prepared to meet the specific needs of children with common or rare nutritional problems. CONCLUSION: Health care providers who use nutrient modules must understand the importance of diet composition and the careful monitoring of pediatric patients.

Child↗

A fresh look at the risks of artificial infant feeding.

Declining breastfeeding rates and the aggressive marketing of breastmilk substitutes has blurred the distinction between breastmilk and formula. Claims that infant formula is safe, economical, easy to use, and nutritionally complete are challenged in this article, the intent of which is to raise the awareness of health workers to the non-publicized side of infant formula. Non-proprietary, referenced data is provided to illustrate that formula and breastmilk are not the same thing, and that health outcomes of infants who consume each may be different. Guilt is often cited by health workers as a reason to avoid informing parents about the risks of artificial feeding. Suggestions are offered for addressing this reasoning.

Attitude of Health Personnel↗

Increase in plasma phospholipid docosahexaenoic and eicosapentaenoic acids as a reflection of their intake and mode of administration.

The fatty acid, docosahexaenoic acid (DHA, 22:6n-3), is a major constituent of red blood cell phosphatidylethanolamine and phosphatidylserine at birth but declines in all phospholipid classes following preterm delivery unless the diet contains DHA. A bolus of fish oil prevented declines in DHA of red cell phospholipids (phosphatidylethanolamine, phosphatidylcholine, and phosphatidylserine) during 4 to 6 wk of feeding, with red blood cell DHA indistinguishable from that of infants fed human milk. The amount of DHA fed was almost an order of magnitude greater than usually provided by human milk, however, suggesting poor absorption of fish oil by preterm infants. The purpose of these studies was to determine if uptake of fish oil DHA could be improved by dispersion in preterm formula. Since plasma phospholipids rapidly reflect changes in dietary fatty acid composition, DHA uptake was assessed by fatty acid analysis of plasma phosphatidylethanolamine and phosphatidylcholine. All groups receiving fish oil (both bolus and dispersed) demonstrated a rise in plasma phospholipid phosphatidylethanolamine DHA. Infants receiving 11 mg/kg/day DHA from dispersed fish oil, however, appeared to absorb as much or more as those receiving 71 mg/kg/day DHA in a bolus. The lower intake of DHA provided only 0.2% of total dietary fatty acids (human milk typically provides 0.1 to 0.3%). This study, in conjunction with an earlier report, demonstrates the feasibility of 1) long-term maintenance of red cell membrane DHA by its inclusion in infant formula and 2) DHA maintenance by "physiological" intakes of DHA; i.e. the amount provided by human milk.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗