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The response to dietary treatment of patients with chronic post-infectious diarrhea and lactose intolerance.

The response to dietary treatment of patients with chronic post-infectious diarrhea and lactose intolerance was prospectively studied in 29 infants less than 1 year of age. All had gastroenteritis with diarrhea which persisted for more than 3 weeks. In the hospital, diarrhea continued and lactose intolerance was documented while being fed half-strength cow's milk formula. They were given dietary treatment with one of three formulas used for treatment of diarrhea in infancy. Improvement of diarrhea was more frequently achieved with Pregestimil when given as the initial therapy than with the other two formulas. With Pregestimil nine of 10 patients improved whereas only four of nine infants fed Portagen and one of 10 patients initially treated with soy formula improved. Pregestimil was also effective in three of five patients who initially failed to improve with Portagen and in four of eight patients tried with soy formula with or without carbohydrate. Additionally, in the patients who improved, recovery was more rapidly achieved with Pregestimil than with the other two formulas. Formula failures were due to intolerance to glucose polymers in three patients, possibly to protein in seven infants, and an intolerance to all nutrients in five patients. The improvement of the diarrhea was slower in patients who had evidence of colitis in rectal biopsies regardless of the dietary treatment given, but was not correlated with other variables, i.e., etiology of diarrhea, jejunal histology, or duration of diarrhea prior to treatment. However, as a group, the patients who failed to respond to Pregestimil were younger (less than 3 months of age), had more formula changes and associated infections, and were given more antibiotics; they also had more prolonged diarrhea before treatment and more severe jejunal mucosal lesions and jejunal bacterial overgrowth. The data suggests that Pregestimil seems to be the most effective formula for the treatment of infants with chronic post-infectious diarrhea and lactose intolerance.

Age Factors↗

Hydrolysed protein accelerates the gastrointestinal transport of formula in preterm infants.

UNLABELLED: Vomiting, large gastric residuals and abdominal distension are common in very immature infants on formula feeding. The present trial investigated whether a protein hydrolysate formula reduces the gastrointestinal transit time in preterm infants. Fifteen preterm infants (median gestational age 29 (24-32) wk, birthweight 1241 (660-1900) g, postnatal age 18 (5-54) d) on full enteral feeds (>150 ml/kg*d) were enrolled. It was hypothesized that the gastrointestinal transit time is at least 2 h shorter when protein hydrolysate formula is fed compared with standard preterm formula. In a randomized cross-over design study, each formula was fed for 5 d. On days 4 and 9 the gastrointestinal transit time was estimated using carmine red. The protein hydrolysate formula had a markedly shorter gastrointestinal transit time (9.8 h) than the standard formula (19 h) (p = 0.0022, two-sided Mann-Whitney U test). CONCLUSION: The hydrolysate protein formula accelerated gastrointestinal transit of milk and stools, but whether hydrolysate formulas enable a more rapid establishment of full enteral feeding in preterm infants needs to be investigated.

Carmine↗

Immunoreactive substance P and calcitonin-gene-related peptide (CGRP) in rat milk and in human milk and infant formulas.

This study examined the presence of substance P and calcitonin-gene-related peptide (CGRP) immunoreactivities in various milks and infant formulas. Rat milk was obtained from lactating dams between parturition and weaning (0, 2, 5, 10, 15, and 20 d postpartum). Samples of human milk were obtained from seven multiparous, nonsmoking white women, and newborn infant formulas were purchased from local stores. Substance P and CGRP were measured by competitive enzyme immunoassay using acetylcholinesterase-peptide conjugates as tracers. In rats, substance P and CGRP were below detectable concentrations in amniotic fluid from the last day of gestation. In contrast, in milk the concentrations of substance P and CGRP-like immunoreactivities were high on the first day of lactation (3.1 +/- 0.2 and 23.1 +/- 1.5 micrograms/L, respectively), then dropped after day 2 (1.6 +/- 0.7 and 7.5 +/- 0.4 microgram/L, respectively) and remained fairly constant until weaning. Significant concentrations of substance P and CGRP were found in human milk (129.2 +/- 27 ng/L and 4.5 +/- 0.7 microgram/L, respectively, at 15 wk), but substance P or CGRP could not be detected in any of the formulas tested. These data show that milk contains high concentrations of immunoreactive substance P and CGRP. In rats the absence of peptides in amniotic fluid suggests that there is a flood of peptides into the gastrointestinal tract of neonates when suckling is initiated. Significant concentrations of substance P and CGRP in human milk but not in infant formulas may therefore have physiologic implications for neonatal nutrition.

Amniotic Fluid↗

An evaluation with piglets of bovine milk, hydrolyzed bovine milk, and isolated soybean proteins included in infant milk formulas. I. Effect on organ development, digestive enzyme activities, and amino acid digestibility.

A study, using the piglet as a model for the human infant, was undertaken to determine the effect of the protein source of a milk formula on organ development, the activity of digestive enzymes, and the absorption of amino acids as measured at the terminal ileum and over the entire digestive tract. Three isocaloric liquid milk formulas containing equal amounts of either intact bovine milk, hydrolyzed bovine milk, or isolated soybean protein as the sole source of this nutrient and with equal levels of fat and carbohydrate were each given to six 14-day-old piglets over a 19-day period in a manner that mimicked human infant feeding practice. Following a 6-day metabolism study, the piglets were killed, their organs removed, and samples of digesta collected. The protein source of the milk-based formula did not affect (p greater than 0.05) the weight/unit body weight of the small intestine, large intestine, liver, or pancreas, but the relative weight of the kidneys was lower (p less than 0.05) for animals fed the intact bovine milk-based formula and that of the stomach was higher (p less than 0.01) for piglets receiving the isolated soybean formula. The activities of pepsin, intestinal trypsin and chymotrypsin and pancreatic chymotrypsin were not influenced (p greater than 0.05) by protein source, but piglets receiving the bovine milk-based formula had a lower level of activity (p less than 0.01) for pancreatic trypsin. The apparent ileal and fecal absorption of nitrogen was similar for the three milk-based formulas, the overall mean ileal absorption of nitrogen (+/- SE) being 89.0% (+/- 1.44). Excluding cystine, where ileal absorption was relatively lower (p less than 0.05) with the isolated soybean formula (86.7%) compared with the intact bovine milk (91.5%), protein source had little effect on the apparent absorption of essential amino acids. It was concluded that the replacement of intact cow's milk protein in human infant formulas by either hydrolyzed cow's milk or isolated soybean protein is unlikely to cause any major disturbance in the digestive process.

Amino Acids↗

Hydrolyzed versus nonhydrolyzed protein diet in short bowel syndrome in children.

BACKGROUND: There is no consensus regarding the optimal enteral formula in patients with neonatal short bowel syndrome. The common practice in many centers is to give a semielemental diet. METHODS: To test the hypothesis that hydrolyzed protein is not superior to standard formula in promoting growth and development of children with short bowel syndrome, 10 children aged 4.08 +/- 2.45 months (mean +/- SD) underwent a prospective, randomized, crossover, double-blind study lasting 60 days (with crossover on day 31). Two enteral formulas, which differed only with respect to the nitrogen form-hydrolyzed and nonhydrolyzed whey protein-were used. The endpoints of the study were nitrogen balance and intestinal permeability measured by the sugar absorption test (lactulose/mannitol excretion ratio). RESULTS: Energy intake from enteral formula in patients fed hydrolyzed and nonhydrolyzed formula was the same and amounted to about 31% of total intake. The ratio of total energy intake (enteral and parenteral) to resting energy expenditure was 1.7 +/- 0.5 and 1.5 +/- 0.3 in patients fed hydrolyzed and non hydrolyzed formula respectively. Nitrogen balance was 0.28 +/- 0.05 g/kg/d and 0.29 +/- 0.05 g/kg/day, respectively. Lactulose/mannitol ratio before the study was 0.85 +/- 0.85 and after hydrolyzed and nonhydrolyzed formula was 0.59% +/- 0.51% and 0.69% +/- 0.72%, respectively. CONCLUSION: Intestinal permeability, energy, and nitrogen balance in short bowel syndrome were not influenced in the short term by hydrolysis of the enteral nitrogen source.

Cross-Over Studies↗

Postoperative chylous ascites.

The case of an infant, aged 2 months and 23 days, with chylous ascites after nephrectomy is reported. Nephrectomy was performed because of a large hydronephrosis. Chylous ascites was treated with medium-chain triglycerides, diet and cholestyramine. After 3 days the volume of the abdomen was reduced and on day 8 chylous ascites was not visible clinically or ultrasonographically.

Chylous Ascites↗

Evaluation of full-term infants fed an evaporated milk formula.

The objective of this prospective, cohort study was to compare the nutritional status of full-term infants who were fed human milk (BF, n = 29), formula (FF, n = 30) or evaporated milk formulae (EM, n = 30) for at least 3 months. Infants were seen at enrollment, 3 and 6 months, at which times a blood sample, diet record and anthropometric data were collected. Infants in the EM group received solids earlier (12 +/- 5 weeks) than did FF infants (15 +/- 4 weeks), and both were earlier than BF infants (19 +/- 4 weeks). Only 26% of the EM fed group received iron supplements as ferrous sulphate drops. Seven BF, 12 FF and 20 EM had abnormal ferritin values (< 10 ng ml-1) at 6 months. Copper intake was lower in the EM infants at 3 and 6 months. However, plasma copper and erythrocyte copper zinc superoxide dismutase (ZnCuSOD) levels did not differ between groups. Selenium intake was lower in the EM group (5 +/- 1 and 10 +/- 5 micrograms d-1; 3 and 6 months) than in the FF infants (13 +/- 4 and 19 +/- 7 micrograms d-1; 3 and 6 months). Erythrocyte SeGHSPx levels in EM infants were lower at 6 months (EM, 33.2 +/- 3.4; FF. 35.2 +/- 3.9: BF, 36.1 +/- 3.8 mU mg Hb-1). Thiamin intake (0.99 +/- 0.08 and 1.24 +/- 0.32; 3 and 6 months, mg 1000 kcal-1) was higher in the FF group than in EM infants (0.38 +/- 0.39 and 0.66 +/- 0.38; 3 and 6 months). There were more (13%) abnormal thiamin assays in the EM group at 6 months than in the BF and FF infants (0%). In conclusion, infants fed evaporated milk formula receive adequate copper but may not receive enough thiamin or selenium. Unless supplemented from birth with medicinal iron, intakes of iron will be inadequate.

Animals↗

Evidence that phenylalanine hydroxylation rates are overestimated in neonatal subjects receiving total parenteral nutrition with a high phenylalanine content.

Recent publications have indicated that the parenterally fed neonate has a substantial ability to hydroxylate phenylalanine. Examination of these data suggests that, at high phenylalanine intakes, estimated rates of hydroxylation exceed rates of intake. This implies significant net tissue breakdown. However, the quantitative validity of the estimates of phenylalanine hydroxylation cannot be assessed without nitrogen balance data. We have recently developed a parenterally fed neonatal piglet model and have used this to study aromatic amino acid metabolism in piglets fed different amino acid solutions. Reappraisal of the data from these studies has allowed us to estimate both phenylalanine hydroxylation and tissue protein accretion. Piglets were parenterally fed Vamin [292 micromol of Phe x kg(-1) x h(-1), 26 micromol of Tyr x kg(-1) x h(-1)], Vaminolact + Phe [VLP, 277 micromol of Phe x kg(-1) x h(-1), 26 micromol Tyr x kg(-1) x h(-1)], or Vaminolact + glycyl-L-tyrosine [VLGT, 152 micromol of Phe x kg(-1) x h(-1), 159 micromol of Tyr x kg(-1) x h(-1)] for 8 d. Nitrogen balance was measured over the last 5 study d, and aromatic amino acid kinetics were determined using a primed continuous infusion of L-[1-4C]phenylalanine on d 8. Average body protein gain, derived from nitrogen balance, was 11 g x kg(-1) x d(-1). For the Vamin and VLP groups, the rates of phenylalanine hydroxylation were estimated to be 139 and 90% of intake, respectively. However, phenylalanine hydroxylation was only 16% of intake for the VLGT group. In view of the tissue protein accretion data, it appears that the rate of phenylalanine hydroxylation may be overestimated in neonates fed high phenylalanine parenteral nutrition. The extent to which the parenterally fed neonate can adapt to a high phenylalanine intake, by increasing the rate of phenylalanine hydroxylation, remains to be determined.

Amino Acids↗

[Growth, acceptance, and tolerance with a new milk formula].

The purpose of this investigation was to evaluate the effect of a modified cow's milk formula on growth, tolerance and acceptability, which was studied in 2,097 infants selected from those controlled in primary health centers at Santiago, Chile: 1,119 were fed a modified cow's milk formula (LPM), while an unmodified powdered cow's milk (LP) was given to 978 controls of the same age and conditions, as well as solid foods after 4 months of age. Both experimental and control groups were followed along a 4 months period for records of anthropometric data, morbidity, acceptability and tolerance for LP and LPM. We did not find significant differences in growth (values ranging 95 to 100% of NCHS standards W/A or H/A). A slightly higher energy intake and lower protein intake was observed with LPM. Gastrointestinal symptoms were infrequently seen and of similar frequency and character in both 0 to 4 month old groups (4.3% with LPM vs. 5.3% with LP at first control). These gastrointestinal signs were more frequently recorded under LPM than with LP in the 8 to 12 months old group only at first control (colics 8% vs. 4% p < 0.01 and abnormal stools 9.4% vs. 5.5% p < 0.01). Acute acceptability expressed as percentage withdrawal from study was not significantly lower with LPM than LP (5 to 15% vs. 2% N.S.). The proposed modified formula seems to be a good alternative to powdered cow's milk for infants.

Animals↗

Sample preparation and liquid chromatographic determination of vitamin D in food products.

Vitamin D in different fortified foods is determined by using liquid chromatography (LC). Sample preparation is described for fortified skim milk, infant formulas, chocolate drink powder, and diet food. The procedure involves 2 main steps: saponification of the sample followed by extraction, and quantitation by LC analysis. Depending on the sample matrix, additional steps are necessary, i.e., enzymatic digestion for hydrolyzing the starch in the sample and cartridge purification before LC injection. An isocratic system consisting of 0.5% water in methanol (v/v) on two 5 microns ODS Hypersil, 12 X 0.4 cm id columns is used. Recovery of vitamin D added to unfortified skim milk is 98%. The results of vitamin D determination in homogenized skim milk, fortified milk powder, fortified milk powder with soybean, chocolate drink powder, and sports diet food are given.

Animals↗

[Urinary excretion of iodide and incidence of goiter in Styria--studies 20 years after the introduction of compulsory iodinated salt prophylaxis].

20 years after introduction of iodized salt prophylaxis by law in Austria the iodine supply of 6 to 19 year-old school children in Styria was examined. In this study we compared the goitre incidence and urine iodine excretion in children from regions with low iodine intake (locations Graz and Oberwölz) with those of an area where iodine supply was augmented by drinking local iodine containing mineral water (area of Sicheldorf). A modified ceric ion arsenate method was applied for determining urinary iodine excretion. Both in the city of Graz and the rural locality of Oberwölz there still exists an iodine deficiency, grade I (Urine iodine excretion of 50 and 65 micrograms I/g Cr respectively). The goitre incidence in 6 to 10 year olds in Graz amounted to only 4%, while Oberwölz records 8%. This figure in juveniles was relatively high already with 12% in Graz and 15% in Oberwölz. The age group of 15 to 19 years at the Graz secondary school showed a goitre incidence of 12%. The results of the 6 to 10 year olds in the Sicheldorf area recorded a goitre incidence of 4%. Urinary iodine excretion in Sicheldorf: 132,64 micrograms J/g Kre.

Adolescent↗