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Special formulas in infant nutrition: a review.

Special formulas should only be used by medical prescription and for those lactating infants with diagnosed nutritional problems. Lactose-free formulas or those based on soy are the logical choice when the exclusion of lactose from the diet is considered necessary. At present, there is no concensus on the appropriateness of soy formulas for the treatment and prevention of nutritional allergies and current opinion seems to favour hydrolyzed protein formulas. High-degree protein hydrolysate formulas are used to treat lactating infants with an allergy to cow milk proteins or with serious nutritional problems. These formulas are not without risk, as they may contain residual epitopes capable of provoking a severe allergic reaction. Before using these formulas, allergenicity tests should be performed, particularly for highly sensitive infants. The unpleasant taste and high cost of these formulas, in addition to possible nutritional problems, limit their use in the prevention of atopic disease, although their efficacy is well established. Partially protein hydrolysate formulas are only used for preventive purposes and are not suitable for lactating infants with a proven allergy to cow milk. Although these formulas can reduce the incidence or delay the appearance of certain atopic symptoms, they have not been shown to prevent IgE-mediated allergic reactions to cow's milk and so their effectiveness is open to question.

Dietary Proteins↗

A new chromatographic instrument for measuring trace concentrations of breath-hydrogen.

A new instrument has been developed which offers many advantages over instruments presently utilized for the measurement of breath-hydrogen used to evaluate the intestinal absorption of sugars. The gas analyzer has a solid-state sensor which is more specific for hydrogen than most conventional chromatographic detectors. Air can be used as the carrier gas and can be circulated with a small internal pump, thereby eliminating large carrier gas tanks and pressure regulators. The intersample time is approximately 2 min, allowing rapid serial analysis of breath samples. A unique feature allows a short-term memory circuit to recall the signal and present it on a digital panel meter in parts per million. Recorder terminals on the back permit the generation of a permanent record, if desired. The gas analyzer is small, light-weight and simple to operate. Its application to the serial measurement of hydrogen in alveolar air after ingestion of sugars is demonstrated.

Breath Tests↗

Gas chromatographic quantitation of breath hydrogen and carbon monoxide for clinical investigation in adults and in children.

A simple and suitable method of breath sampling and the gas chromatographic determination of H2 and CO in breath of children as well as of adults are described. The analytical system allows the measurement of concentrations of H2 and CO as low as a few ppm. The proposed method of breath collection (tedlar bag with low resistance valve face mask) appears particularly useful for long storage purposes, because it eliminates the need for additional manipulations and the possible associated sample dilution. Normalization of H2 breath amounts to internal standard O2 to obtain reliable and precise measurements is particularly useful in non-collaborating patients whose observed H2 peak values increase by 15% after the correction. The overall procedure is fast, inexpensive and accurately recognizes adult or children lactose malabsorbers as well as subjects exposed even to low levels of CO.

Adult↗

Hypolactasia and metabolic changes in post-menopausal women.

OBJECTIVES: The aims of the study were to evaluate the prevalence of hypolactasia in a group of post-menopausal women in Southern Italy, and to relate hypolactasia to possible changes occurring in biochemical indicators of carbohydrate and fat metabolism as well as in biochemical markers of bone metabolism. METHODS: Fifty post-menopausal women entered the study. Lactose malabsorbers were identified by breath hydrogen test. The kinetics of D-xylose was evaluated by a graphic-mathematical analysis after oral administration of a solution of 10 g of D-xylose in water. Serum glucose, insulin, C-peptide, cholesterol and triglycerides were assayed by commercial kits. The evaluation of dietary habits and physical activities was performed by a questionnaire. The assessment of bone turnover was obtained by measuring osteocalcin, serum alkaline phosphatase, calcium, phosphorus, and urinary hydroxyproline and urinary calcium expressed as a ratio or urinary creatinine. RESULTS: Twenty-six of 50 women showed hypolactasia. Significant differences were found in serum levels of insulin, glucose, and triglycerides, which were lower in malabsorbers than lactose absorbers, and in HDL-cholesterol levels which were higher in the first group than in the second. As regards bone turnover, dietary habits or lactose intake, there were no significant differences between the two groups. CONCLUSIONS: The significant differences found in serum levels of glucose, triglycerides, and HDL-cholesterol between lactose absorbers and malabsorbers may be imputable to the low or absent lactase activity which does not allow the whole amount of lactose in the small bowel of malabsorbers to be metabolized. Moreover, changes in lactose absorbing capacity of intestinal mucosa did not modify the intake of milk or its by-products in malabsorbers as demonstrated by the analysis of food.

Adult↗

A case of type 2 Gm1-gangliosidosis with long survival.

An 11-year-old boy with type 2 GM1-gangliosidosis was presented, providing further evidence for the clinical and biochemical heterogeneity of the disease. The patient had several characteristics of type 2 GM1-gangliosidosis, but was different from so-called typical type 2 GM1-gangliosidosis from the point of view of survival and the degree of GM1-ganglioside accumulation. GM1-gangliosidosis was diagnosed by absence of beta-galactosidase activity in leukocytes and the parents had the enzyme levels of heterozygotes. However, the amount of the brain GM1-ganglioside was accumulated to a less degree in comparison with that of typical type 2 GM1-gangliosidosis, though the activity of GM1-beta-galactosidase in the brain was deficient to the same degree as in the typical case.

Child↗

Review of probiotics available to modify gastrointestinal flora.

There is evidence that the oral consumption of micro-organisms produces a protective effect on the gut flora. A significant number of studies suggests that probiotics might have beneficial effects on several microbial disorders of the gut, but it is very difficult to define the clinical efficacy of such products. In this review, we report the results of studies on traveller's diarrhoea (TD), antibiotic associated diarrhoea (AAD) and acute diarrhoea (AD) in which various probiotic preparations have been used in controlled trials and been shown to have a beneficial therapeutic or prophylactic effect.

Anti-Bacterial Agents↗

Testing evolutionary hypotheses about human biological adaptation using cross-cultural comparison.

Physiological data from a range of human populations living in different environments can provide valuable information for testing evolutionary hypotheses about human adaptation. By taking into account the effects of population history, phylogenetic comparative methods can help us determine whether variation results from selection due to particular environmental variables. These selective forces could even be due to cultural traits-which means that gene-culture co-evolution may be occurring. In this paper, we outline two examples of the use of these approaches to test adaptive hypotheses that explain global variation in two physiological traits: the first is lactose digestion capacity in adults, and the second is population sex-ratio at birth. We show that lower than average sex ratio at birth is associated with high fertility, and argue that global variation in sex ratio at birth has evolved as a response to the high physiological costs of producing boys in high fertility populations.

Adaptation, Physiological↗

Perspectives on intake of calcium-rich foods among Asian, Hispanic, and white preadolescent and adolescent females.

OBJECTIVE: Declining calcium intake among adolescents warrants attention. Our objective was to identify influences on adolescents' consumption of calcium-rich foods. DESIGN: Focus groups were conducted with girls representing 2 age groups (11 to 12 or 16 to 17 years) and 3 macroethnic groups (Asian, Hispanic, or white). SETTING: Public schools in 10 states. PARTICIPANTS: A convenience sample (n = 200) was recruited through schools. VARIABLES MEASURED: Focus groups (n = 35) were audiotaped and transcribed. Influences relative to consumption of milk or other calcium-rich foods were identified. ANALYSIS: Comments were coded as motivators or barriers within each focus group. Content analysis procedures were used to compare ethnic and age groups. RESULTS: A barrier to milk consumption that was more common among older girls and Asian groups was the limited expectation within families for drinking milk. Many controlled their own beverage choices, and milk, even if liked, was only one option. Milk was positively associated with strength and bone health, but these attributes were viewed as being more important for boys than girls. Milk was associated with breakfast, school lunches, cereal, and desserts. White girls had the most positive reactions to milk and Hispanic girls the most negative. All groups were positive toward pizza, ice cream, and cheese. CONCLUSIONS AND IMPLICATIONS: To improve calcium intake among teens, interventions should include a family component, stress the benefits of milk for girls, and focus on breakfast.

Adolescent↗

Improved parameters of lactose maldigestion using lactulose.

Lactulose is a disaccharide derived from lactose. There has been recent rekindling of interest in the possible benefits of pro- and prebiotics: mainly, lactic acid-producing bacteria and lactulose for the lower intestine. Since lactose maldigestion is a common genetic trait, we undertook this study to delineate similar effects between these two disaccharides. Nine healthy lactose maldigesting subjects underwent two separate periods of three weeks adaptation, first with 10 g twice daily lactulose and then 1.5 g twice daily lactose (in milk). Adaptation was defined by reduced breath Hydrogen (BH2) and symptoms after 50 g lactose challenges. In six subjects fecal beta-galactosidase was measured. All subjects consumed some lactose daily. In the first period, eight subjects improved symptoms and reduced BH2 significantly, while in the second period they did not. Fecal beta-galactosidase significantly increased after lactulose. This study supports the notion that lactulose and lactose may have similar clinical effects.

Adaptation, Physiological↗

Fecal hydrogen production and consumption measurements. Response to daily lactose ingestion by lactose maldigesters.

The alteration of hydrogen (H2) metabolism, which accounts for the large decrease in breath H2 excretion following prolonged ingestion of malabsorbed carbohydrate (lactulose, lactose in lactose maldigesters) was studied in six lactose-maldigesting adults. Metabolic inhibitors of the three main H2-consuming reactions (methanogenesis, sulfate reduction, and acetogenesis) were used to independently measure H2 production and consumption in fecal samples obtained after 10 days of either dextrose or lactose feeding. Absolute fecal H2 production (net of production minus consumption) after 3 hr of incubation with lactose was approximately threefold lower after lactose adaptation (242 +/- 54 microliters) compared to dextrose adaptation (680 +/- 79 microliters, P = 0.006). Fecal H2 consumption was not affected by either feeding period. We conclude that decreased absolute H2 production, rather than increased H2 consumption, is responsible for the decrease in breath H2 observed with lactose feeding.

Adult↗

Management of lactose maldigestion by consuming milk containing lactobacilli.

The influence of nonfermented milk containing L. acidophilus or L. bulgaricus on lactose utilization by lactose maldigesters was investigated. Nonfermented milks containing L. acidophilus or L. bulgaricus at 10(8) and 10(9) CFU/ml were prepared using 2% low-fat milk. Lactose maldigestion was monitored by measuring breath hydrogen at hourly intervals for 8 hr following consumption of 400 ml of each diet. Nonfermented milk containing L. acidophilus B at 10(8) CFU/ml were not effective in reducing breath hydrogen and symptoms. Nonfermented milk containing L. acidophilus B at 10(9) CFU/ml only slightly decreased breath hydrogen production; however, the symptoms were significantly improved. Nonfermented milks containing L. bulgaricus 449 at 10(8) and 10(9) CFU/ml were effective in reducing breath hydrogen and symptoms. The results for bulgaricus milk were all significant. In this study, L. acidophilus B and L. bulgaricus 449 were chosen because of their similar beta-galactosidase activity and bile sensitivity. L. acidophilus and L. bulgaricus are both thermophilic lactobacilli and an active transport (permease) system is found in both species for lactose transport. The major factor affecting in vivo lactose digestion in this study appears to be the bacterial cell wall/membrane structures. That the cell wall/membrane structures of L. acidophilus are different from those of L. bulgaricus can be indirectly proven by the results of sonication time for maximum beta-galactosidase activity measurement. The results of this study indicate that L. bulgaricus is usually a better choice than L. acidophilus for manufacturing nonfermented milks for lactose maldigesters.

Animals↗

Fructose and sorbitol malabsorption in ambulatory patients with functional dyspepsia: comparison with lactose maldigestion/malabsorption.

The aim of this study was to study sugar maldigestion/malabsorption in patients with functional dyspepsia using H2 breath testing. End-expiratory breath H2 after separate challenges with lactose (25 g), fructose (25 g), and sorbitol (5 g) were used to determine malabsorption, as well as small bowel transit time (SBTT). Five hundred twenty patients with functional dyspepsia received all three challenges. Smaller groups were also tested after lactulose (10 g, N = 36) and glucose (50 g, N = 90) challenges. Fructose and sorbitol were closely linked with respect to absorption and malabsorption status. Only in the case of lactose maldigestion/malabsorption was there a greater than random prevalence of malabsorption (P < 0.001) for fructose and sorbitol. In contrast to lactose, ethnic origin did not influence fructose or sorbitol malabsorption, and females predominated among fructose and sorbitol malabsorbers. In Jews, the prevalence of lactose maldigestion/malabsorption decreased in the age group of 25-55 and subsequently rose after 55, while fructose and sorbitol malabsorption decreased progressively with advancing age. With respect to small bowel transit time (SBTT), in the case of sorbitol and lactulose, it was significantly greater (P < 0.05) than those for fructose and lactose. Multiple sugar malabsorptions are common when lactose maldigestion/malabsorption is present.

Breath Tests↗