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PubMed1997

The cost of not breastfeeding: a commentary.

Breastfeeding, a valuable natural resource, promotes health, helps prevent infant and childhood disease, and saves health care costs. Additional annual national health care costs, incurred for treatment of four medical conditions in infant who were not breastfed were estimated. Infant diarrhea in nonbreastfed infants costs $291.3 million; respiratory syncytial virus, $225 million; insulin-dependent diabetes mellitus, from $9.6 to $124.8 million; and otitis media, $660 million. Thus, these four medical diagnoses alone create just over $1 billion of extra health care costs each year. Breastfeeding may also enhance intellectual development of children according to at least one medical research study. The potential societal benefits of more intelligent children is incalculable even though it cannot be directly measured in terms of dollars. Finally, it was calculated that an additional $2,665,715 in federal funds is needed yearly in order for WIC to provide infant formula to nonbreastfeeding mothers. For the average family, the cost of purchasing formula is twice the cost of supplemental food for the breastfeeding mother. Breastfeeding education and support should be an integral part of health care, especially under managed care which rewards the prevention of health problems and reduced use of health services.

Bottle Feeding↗
PubMed2004

Soy protein formulas in children: no hormonal effects in long-term feeding.

Recently, the finding of high plasma concentration of phyto-oestrogens in soy protein formula (SPF) fed children has focused scientific attention on the phyto-oestrogens (isoflavones genistein, daidzein, and their glycosides) contained in SPFs. The aim of this study was to evaluate some hormonal and metabolic effects of long-term (more than 6 months) SPF feeding. We enrolled 48 children, mean age 37 months (range 7-96 months), 27 males and 21 females. All children underwent physical examination. Bone age, urinary markers of bone metabolism, serum levels of bone alkaline phosphatase, osteocalcin, 17beta-oestradiol, and intact parathyroid hormone were measured. Eighteen healthy children represented the control group. No abnormalities were observed in auxological parameters; none of the enrolled girls showed signs/symptoms of precocious puberty and none of the boys presented gynecomastia; bone age was within the normal range. The serum level of bone alkaline phosphatase, osteocalcin, 17beta-oestradiol, and intact parathyroid hormone, and the urinary levels of the markers of bone metabolism were all within normal values. We conclude that long-term feeding with SPFs in early life does not seem to produce oestrogen-like hormonal effects.

Body Height↗
PubMed1998

Role of the ketogenic diet in children with intractable seizures.

OBJECTIVE: To provide a review of the mechanism of action, clinical efficacy, adverse effects, drug interactions, and therapeutic considerations associated with the use of a ketogenic diet to manage patients with intractable seizures. DATA SOURCES: A MEDLINE search from January 1966 to the present and relevant articles from journals were reviewed. DATA SYNTHESIS: The ketogenic diet has been used as a treatment modality since the early 1920s to control intractable seizures. The exact mechanism of action is unknown. Overall, uncontrolled clinical studies have reported that approximately one-third of patients with intractable seizures have become seizure-free on the ketogenic diet. Common adverse events attributed to the diet include dehydration, gastrointestinal symptoms, hypoglycemia, as well as carnitine and vitamin deficiencies. Cognitive effects, hyperlipidemia, impaired neutrophil function, urolithiasis, optic neuropathy, osteoporosis, and protein deficiency may also occur in some patients. Carbohydrate content and drug formulation in the selection of medications while on the diet are important. Acetazolamide, phenobarbital, and valproic acid have been reported to interact with the ketogenic diet. Medications that cause carnitine deficiency or influence carbohydrate metabolism should also be used with caution. The carbohydrate content of drugs in various therapeutic classes is presented to aid in the selection of the most appropriate drug and formulation for patients on the ketogenic diet. The success of the diet in controlling intractable seizures is related to the patient's close adherence to the diet. Minimizing carbohydrate ingestion from medications along with a multidisciplinary team approach to the selection and monitoring of the diet are important to the success of the ketogenic diet in controlling seizures. CONCLUSIONS: The ketogenic diet has shown promising results in controlling intractable seizures; however, carefully controlled clinical trials are needed to better assess the efficacy of the diet during its use and after discontinuation.

Acetazolamide↗
PubMed2001

Cassava-soy weaning food: biological evaluation and effects on rat organs.

Weaning food was formulated using a cassava product, 'Tapioca' (TAP), supplemented with roasted-sprouted soybeans (SS), with and without additional (10%) malted sorghum flour (MS). Biological evaluation was carried out on the formulations using 4-5 week old weanling albino rats, with Cerelac (a commercial maize-milk weaning food) as the control diet. There were increases in growth rate of rats fed with both the test and control diets. There were no significant (p >0.05) differences between the test diets and control diet in true digestibility values. The biological value (BV) and net protein utilization (NPU) values for the formulated diets were above the recommended minimum values. The weight of organs (small intestine, pancreas, liver and heart) of rats fed TAP + SS and TAP + SS + MS based diets were not higher than those of organs of rats fed Cerelac. It was concluded that cassava products could potentially be employed successfully in the preparation of weaning foods of comparable quality to available commercial brands.

Animals↗
PubMed2005

Population pharmacokinetics of epinastine, a histamine H1 receptor antagonist, in adults and children.

AIMS: Our objective was to develop a population pharmacokinetic (PPK) model for epinastine, a histamine H(1) receptor antagonist, in adults and children and to obtain pharmacokinetic information to support dosing recommendations in children. METHODS: A total of 1510 plasma samples were collected from 62 healthy adult volunteers and 62 paediatric atopic dermatitis patients. The data were analysed using the NONMEM program according to a two-compartment model with first-order absorption. In addition, the final PPK model was evaluated by means of bootstrapping resampling. RESULTS: The oral clearance (CL/F) was found to be associated with body weight, formulation and food status. The volume of distribution of the central compartment (V(1)/F) was related to body weight and food status. An absorption lag time was apparent in fed subjects. On the other hand, other covariates (formulation on V(1)/F, volume of distribution of the peripheral compartment (V(2)/F), first-order absorption rate constant (Ka) and absorption lag time (ALAG); food status on V(2)/F and Ka; body weight on V(2)/F) were not statistically significant. No effect of age on CL/F, V(1)/F or V(2)/F was found. The mean parameter estimates obtained with an additional 200 bootstrap replicates of data were within 90-117% of those obtained with the original data set. These results suggest that the pharmacokinetics of epinastine are similar in adults and in children, except for the effect of the difference of body weight. The result of the application of the PPK model to the clinical trial in paediatric patients, in which dosage was determined based on the body weight (from 14 kg to less than 24 kg; 10 mg dose, 24 kg or more; 20 mg dose), showed that the C(max) and AUC (25.6 +/- 6.9 ng ml(-1) and 246.8 +/- 68.2 ng h ml(-1)) were almost same levels with those of adults after administration of 20 mg (26.9 +/- 9.1 ng ml(-1) and 281.6 +/- 90.5 ng h ml(-1)). CONCLUSIONS: A PPK model for epinastine was established and further evaluation by bootstrapping indicated that this model is stable. The model shows that, if dosage is adjusted based on the body weight, the epinastine exposure in paediatric patients is similar to that in adults.

Adult↗
PubMed1980

Bacterial contamination in feed ingredients, formulated chicken feed and reduction of viable bacteria by pelleting.

The number of bacteria in steam-pelleted or crumbled chicken food was compared with the number in individual ingredients and in mash. A few bacteria were detected in white-fish meal processed Alaska pollack. Highest yields were from alfalfa meal. Colonies numbering 3.5 x 10(3)-4.2 x 10(5) were obtained by heart-infusion agar culture, and 2.1 x 10(2)-7.0 x 10(4) with deoxycholate hydrogen sulphide lactose agar, from 1 g mash. After pelleting or crumbling the number of colonies in 1 g was reduced to 0-1.9 x 10(3) and 0-3.0 x 10(0) respectively. Bacteria in the lactose medium, mostly coliform, were observed in only 1 of 18 samples.

Animal Feed↗
PubMedDate not supplied

The use of enteral nutrition in the management of Crohn's disease in adults.

Crohn's disease is a chronic, relapsing disease and none of the treatments developed so far can cure it. Artificial nutrition is effective to both treat malnutrition when present and induce remission. However, striking advances in anti-inflammatory and immunomodulating therapies (including infliximab) and low compliance to treatment in the first trials have limited its place in the management of adults to drug-resistant patients. Randomized controlled trials show that artificial nutrition is effective in >50% of the cases in this selected population. Significant progress has recently been made to improve the palatability (and thus acceptability) of some enteral solutions, which can be consumed by the oral route and as pharmaconutrition. We reviewed the literature on enteral nutrition in adults with Crohn's disease. We present herein the results of the studies performed with antioxidants, glutamine, short-chain fatty acids, prebiotics, probiotics, low microparticle diets, and a TGFbeta2 enriched formulation.

Adult↗
PubMed1988

Differential effect of food on kinetics of bromocriptine in a modified release capsule and a conventional formulation.

The influence of food on release of drug from a modified release capsule of bromocriptine 5 mg (Parlodel SRO) and a conventional formulation of bromocriptine 5 mg has been studied in 8 healthy male volunteers. Both formulations produced objective and subjective effects, such as orthostatic reactions, nausea, dizziness, vomiting and nasal congestion. The modified release capsule caused fewer side-effects than the normal capsule. Both formulations had less cardiovascular effect in the fed than in the fasting state. There was no significant difference between the normal and the modified release capsules taken fasting or after a meal in terms of the AUC extrapolated to infinity. The relative bioavailability of the 5 mg modified release capsule was 84.6% of the normal capsule under fasting conditions and 107.5% after food. In contrast to the virtually unchanged extent of absorption, the rate of absorption was markedly affected by food, especially from the conventional capsule. The mean time of 50% absorption increased from 1.06 h (fasting) to 3.2 h (fed), whereas for the modified release capsule food mainly resulted in an increased lag time of absorption. The almost instantaneous dissolution of bromocriptine from the normal capsule in vitro (both in HCl and fasting human gastric juice) and the delay of absorption after a meal in vivo suggest that the rate limiting step in absorption of the normal capsules is delivery of released drug from the stomach to the small intestine, which is delayed by food. Both the modified release 5-mg capsule and the normal 5-mg capsule showed extended suppression of prolactin over 36 h, in all subjects, both fasted and after a meal.

Adult↗
PubMed1992

Bioavailability of a new controlled-release oral naproxen formulation given with and without food.

The influence of concomitant food intake on the plasma concentration of naproxen given as a new controlled-release (CR) formulation (750-mg tablet) was investigated in a crossover study design. Twelve healthy volunteers received a single tablet of naproxen on two occasions separated by a 3-week washout period:- after an overnight fast and immediately after a standard meal. Plasma naproxen levels were measured through HPLC at intervals suitable for obtaining concentration-time curves of both regimens in the range 1--48 hours. It was found that average plasma AUC values were 1978.7 mcg.hr/ml in fasting participants and 1778.6 mcg.hr/ml in postprandial participants. The confidence interval computed by Westlake's method indicated equivalence of values. Food decreased the peak plasma concentration of CR naproxen by about 14%, but the confidence interval (+/- 22%) barely exceeded equivalence limits. There were no significant differences between fasting versus postprandial values for the mean absorption time, or plasma absorption and disposition half-lifes. It is concluded that the bioavailability of CR naproxen is not substantially altered by the ingestion of food.

Absorption↗
PubMed1995

Residual antigenicity of hypoallergenic infant formulas and the occurrence of milk-specific IgE antibodies in patients with clinical allergy.

BACKGROUND: Milk protein hydrolysates are frequently used in milk substitutes for children with cow's milk allergy. However, cases of hypersensitivity to commercially available hypoallergenic infant formulas based on milk protein hydrolysates have been reported. OBJECTIVE: Our purpose was to determine the immunologic response of milk protein-specific IgE and IgG in the serum of patients allergic to cow's milk against four commercially available hypoallergenic milk protein hydrolysates and eight infant formulas. METHODS: Antibody levels in patients' serum and milk protein-specific residual antigenicity of the hypoallergenic products were determined by indirect and competitive ELISA. RESULTS: Patients allergic to cow's milk had IgE and IgG antibodies to several protein fractions of cow's milk; intraindividual and interindividual variation in the concentrations of these antibodies was considerable. In general, IgE and IgG residual antigenicity of individual milk proteins in the hypoallergenic products was lower compared with that of the intact milk protein, but immunoreactive epitopes could still be detected in all products. Their number varied considerably among the individual milk proteins and also differed among products. CONCLUSIONS: The individual sensitization pattern of the patient allergic to cow's milk and the milk protein-specific residual antigenicity might be considered as possible laboratory predictors of adverse reactions to hypoallergenic products. Their determination could be a useful preclinical screening test for pediatricians to select a formula adapted to the individual patient.

Animals↗
PubMed1999

Energy under-reporting in Swedish and Irish dietary surveys: implications for food-based dietary guidelines.

An analysis of dietary survey data from Sweden and Ireland revealed that with a declining ratio of energy intake to estimated basal metabolic rate (EI:BMR), %energy from fat, saturated fat and carbohydrate fell while that of protein increased. However, where the definition of under-reporting is less strict, as in the Irish database (EI:BMR) < 1.27), the quantitative effect on macronutrient balance, while statistically significant, is not of such magnitude as to be of nutritional significance. However, with respect to foods, under-reporting was found to be of considerable significance in using such data to formulate food-based dietary guidelines. The Swedish data show that under-reporting of foods is associated with a decreasing percentage of consumers, decreasing intake per eating occasion and decreasing frequency of eating. The development of food-based dietary guidelines will involve comparisons of patterns of food intake among people with contrasting high or low intakes of target nutrients. The Swedish data compared food intakes for those with low or high intakes of saturated fatty acids (SFA) among under-reporters and acceptable reporters of energy intake. Whereas absolute values were always lower with the lower EI:BMR group (< 1.1) compared to the higher EI:BMR group (> 1.35) the ratio of intakes for the low vs. high SFA groups were broadly significant at either EI:BMR ratio. This paper highlights the difficulties that under-reporting will pose for food-based dietary guidelines.

Adolescent↗
PubMed2000

Treatment of infant colic with amino acid-based infant formula: a preliminary study.

Infant colic, a common disorder of infancy, is characterized by excessive crying and fussing. In this preliminary study we examined whether Neocate, an amino acid-based formula, would be accepted by formula-fed infants with colic, 3-7 wk of age, and whether Neocate would improve their symptoms. Six infants with colic were studied using Barr-type infant behavior diaries for 3-6 d on their current formula and then for 5-17 d on Neocate exclusively. All infants tolerated Neocate well and all improved, usually within 1-2 d. The total time spent crying and fussing was reduced by an average of 45%, representing a decrease of 1.0 to 5.2 h daily. After colic symptoms improved, infants were challenged with oral doses of 75 mg of bovine IgG at a 1 mg/ml concentration in order to assess its potential role in colic. Bovine IgG challenges resulted in increased crying and fussing behavior, suggesting that this protein may be etiologically important.

Administration, Oral↗
PubMed1989

Manganese retention in man: a method for estimating manganese absorption in man.

Whole-body retention of 54Mn was studied in man by measurements in a sensitive whole-body counter after intake of an extrinsically labeled infant formula. Reproducible retention figures at day 10 were observed after repeated administrations to six subjects; 2.3 +/- 1.1, 3.3 +/- 3.1, and 2.4 +/- 1.4% (means +/- SD) for three separate occasions. Interindividual variation of manganese retention after intake of the same labeled diet was, however, shown to be substantial. Retention at day 10 was 2.9 +/- 1.8% (means +/- SD) and varied from 0.6 to 9.2% when measured in 14 healthy subjects. Large interindividual variations in rate of excretion were observed. The retention measurements for days 10-30, however, could be closely fitted to a single exponential function for each individual. The results regarding intraindividual and interindividual variation in Mn retention indicate that factors influencing Mn absorption can be identified only by repeated administrations using each subject as his/her own control.

Administration, Oral↗