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Human milk protein vs. formula protein and their use in preterm infants.
Gianni, ML, Roggero, P, Mosca, F
Current opinion in clinical nutrition and metabolic care. 2019;(1):76-81
Abstract
PURPOSE OF REVIEW We review the current available evidence on the metabolic fate of human milk proteins and their potential clinical implications for growth and body composition development vs. those of formula proteins in preterm infants. RECENT FINDINGS The decreased content of human milk protein in preterm mothers throughout lactation might contribute to the reduced growth reported in exclusively human milk-fed infants compared with that of formula-fed infants. Recent studies have demonstrated that preterm infants are capable of degrading human milk proteins regardless of their degree of prematurity or postnatal age, with limited contribution from milk proteases to protein digestion. The nitrogen balance of fortified human milk-fed preterm infants is higher than that of formula-fed preterm infants. Moreover, the growth of human milk-fed preterm infants appears to be accompanied by fat-free mass deposition. SUMMARY Provided that adequate protein and energy intakes are delivered, human milk enhances protein use rather than oxidation as well as promotes tissue growth, leading to preferential fat-free mass deposition and contributing to the recovery of the body composition in preterm infants. Human milk feeding should be supported and promoted for all preterm mother-infant pairs.
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[Advances in the knowledge about human milk proteins].
Brunser, O
Revista chilena de pediatria. 2018;(2):261-269
Abstract
The mammary gland and maternal milk are the product of millions of years of evolution that resul ted in an optimal composition that sustains the growth and development of newborns and infants. Maternal milk supports the growth, adaptation and survival of this immature organism. Recent studies have detected 1606 different proteins in human milk, most of them synthesized in the acini of the glandular tissue while others originate from distant organs such as the lymphoid tissue and the digestive tract. Maternal milk enzymes modify its proteins and liberate peptides with antimicrobial, antihypertensive or stimulatory activities. This proteolytic activity occurs at specific sites in peptide chains. To prevent the extemporaneous activation of these proteolytic enzymes, that would result in inflammatory processes, maternal milk also contains inhibitory peptides that together with the stimulatory peptides conform a complex regulatory system. Some enzymes in maternal milk main tain their activity in the gastrointestinal tract of infants and compensate for the decreased activity of digestive tract enzymes in newborns. Thus, the milk enterokynase stimulates the release of pancreatic proteases as it induces the liberation of cholecystokynin/pancreozymin. The bile salt-activated lipase of human milk is activated in the duodenum by the infants' bile salts and partially compensates for the low levels of pancreatic lipase in newborns. These milk enzymes probably contribute to the nutrition of premature infants as they increase the availability of amino acids and peptides in their upper gastrointestinal tract; furthermore, as their intestinal epithelium is more permeable to peptides and partially digested protein this may help induce immune tolerance. The most relevant issues in the physiology and composition of the maternal milk are presented in this review.
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Variation in the Protein Composition of Human Milk during Extended Lactation: A Narrative Review.
Verd, S, Ginovart, G, Calvo, J, Ponce-Taylor, J, Gaya, A
Nutrients. 2018;(8)
Abstract
The aim of this review is to evaluate changes in protein parameters in the second year postpartum. There is considerable agreement among authors about the declining trend of human milk protein concentrations, but most research on protein content in breast milk focuses on the first year of life and comes from developed countries. Whereas this is the case for exclusive breastfeeding or for breastfeeding into the first year of life, the opposite applies to weaning or extended breastfeeding. This review is predominantly based on observational epidemiological evidence and on comparative research linking breast milk composition with cutting down on breastfeeding. Studies dating back several decades have shown an increase in the proportion of immunoglobulins, lactoferrin, and serum albumin during weaning. According to the limited data available, it seems likely that the regulation of milk protein composition during involution can be ascribed to alterations in tight junctions. In studies on humans and other mammalian species, offspring suckle more from mothers that produce more dilute milk and the increase in milk protein concentration is positively correlated to a decrease in suckling frequency during weaning. High milk protein contents were first reported in nonindustrial communities where breastfeeding is sustained the longest, but recent papers from urbanized communities have taken credit for rediscovering the increase in protein content of human milk that becomes evident with prolonged breastfeeding. This review presents an overview of the changes in breast milk protein parameters in the second year postpartum to enable milk banks' practitioners to make informed nutritional decisions on preterm infants.
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4.
Milk-derived bioactive peptides and their health promoting effects: a potential role in atherosclerosis.
Marcone, S, Belton, O, Fitzgerald, DJ
British journal of clinical pharmacology. 2017;(1):152-162
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Abstract
Bioactive peptides derived from milk proteins are food components that, in addition to their nutritional value, retain many biological properties and have therapeutic effects in several health disorders, including cardiovascular disease. Amongst these, atherosclerosis is the underlying cause of heart attack and strokes. It is a progressive dyslipidaemic and inflammatory disease where accumulation of oxidized lipids and inflammatory cells leads to the formation of an atherosclerotic plaque in the vessel wall. Milk-derived bioactive peptides can be released during gastrointestinal digestion, food processing or by enzymatic and bacterial fermentation and are considered to promote diverse beneficial effects such as lipid lowering, antihypertensive, immnomodulating, anti-inflammatory and antithrombotic effects. In this review, an overview of the diverse biological effects of these compounds is given, particularly focusing on their beneficial properties on cardiovascular disease and proposing novel mechanisms of action responsible for their bioactivity. Attempts to prevent cardiovascular diseases target modifications of several risk factors such as high blood pressure, obesity, high blood concentrations of lipids or insulin resistance. Milk-derived bioactive peptides are a source of health-enhancing components and the potential health benefit of these compounds has a growing commercial potential. Consequently, they have been incorporated as ingredients in functional foods, as dietary supplements and as pharmaceuticals to promote health and reduce risk of chronic diseases.
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Preterm Human Milk Macronutrient and Energy Composition: A Systematic Review and Meta-Analysis.
Mimouni, FB, Lubetzky, R, Yochpaz, S, Mandel, D
Clinics in perinatology. 2017;(1):165-172
Abstract
This study is a systematic review of the macronutrient and energy composition of preterm human milk to enable the practicing neonatologist to make informed nutritional decisions in preterm infants. Meta-analyses were conducted in all the studies that reported total energy, true protein, fat, and lactose. Protein content decreased massively (by one-half) and significantly from day 1 to 3 at week 10 to 12. There was a significant linear increase in fat, lactose, and energy content during the same timeframe. Theoretic calculations on energy and macronutrient intake of preterm infants must be made according to a lactation time-specific manner.
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Metabolic advantages of higher protein diets and benefits of dairy foods on weight management, glycemic regulation, and bone.
Pasiakos, SM
Journal of food science. 2015;:A2-7
Abstract
The Inst. of Medicine and World Health Organization have determined that 0.8 to 0.83 g protein·kg(-1) ·d(-1) is the quantity of protein required to establish nitrogen balance in nearly all healthy individuals. However, consuming higher protein diets may be metabolically advantageous, particularly for overweight and obese adults attempting weight loss, and for physically active individuals such as athletes and military personnel. Studies have demonstrated that higher protein diets may spare lean body mass during weight loss, promote weight management, enhance glycemic regulation, and increase intestinal calcium absorption, which may result in long-term improvements in bone health. The extent to which higher protein diets are beneficial is largely attributed to the digestive and absorptive properties, and also to the essential amino acid (EAA) content of the protein. Proteins that are rapidly digested and absorbed likely contribute to the metabolic advantages conferred by consuming higher protein diets. The EAA profiles, as well as the digestive and absorptive properties of dairy proteins, such as whey protein and casein, are particularly advantageous because they facilitate a rapid, robust, and sustained delivery of EAAs to the periphery. This article reviews the scientific literature assessing metabolic advantages associated with higher protein diets on weight management, glycemic regulation, and bone, with emphasis given to studies evaluating the potential benefits associated with dairy.
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Transition from fractal to spherical aggregates of globular proteins: Brownian-like activation and/or hydrodynamic stress?
Mahmoudi, N, Gaillard, C, Riaublanc, A, Boue, F, Axelos, MA
Current topics in medicinal chemistry. 2014;(5):630-9
Abstract
We report on the structure of whey protein aggregates formed by a short heating coupled to shear at high temperatures (80-120) and neutral pH in scale-up processing conditions, using gel filtration chromatography, light scattering, small angle neutron scattering, and cryogenic transmission electron microscopy. The results are interpreted in terms of coexistence of residual non-aggregated proteins and aggregates. The characteristics of aggregates such as the size, the aggregation number and the shape evidence two different morphologies. Whereas aggregates formed at 80 °C show a selfsimilar structure down to a length scale of the monomer with a fractal dimension typical for reaction limited cluster aggregation (D~2.2), aggregates formed at higher temperature show a spherical morphology, with the structure from small angle neutron scattering data best modelled with the form factor of a polydisperse sphere. We compare the structure of these aggregates to that of aggregates formed in quiescent conditions at lab scale. The structure transition is interpreted in terms of a non-trivial interplay between three perturbation factors: interparticle interaction, temperature and shear.
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Milk protein-based infant formula containing rice starch and low lactose reduces common regurgitation in healthy term infants: a randomized, blinded, and prospective trial.
Lasekan, JB, Linke, HK, Oliver, JS, Carver, JD, Blatter, MM, Kuchan, MJ, Cramer, JM, Pollack, PF
Journal of the American College of Nutrition. 2014;(2):136-46
Abstract
OBJECTIVE Spit-up (regurgitation) reduction with prethickened milk protein-based infant formulas containing rice starch has been clinically demonstrated in infants with heavy spit-ups but not in otherwise healthy normal infants with common spit-ups. The objective of this study was to evaluate growth, gastrointestinal tolerance, and efficacy to reduce common spit-up in normal, healthy term infants fed an investigational rice starch prethickened lactose-free milk protein-based infant formula. METHODS This double-blind, randomized, parallel study evaluated the investigational rice starch prethickened lactose-free (low lactose < 100 mg/L) milk protein-based infant formula compared to a standard, commercially available, iso-nutrient, lactose-containing (100% of carbohydrate) milk-based infant formula (control) for growth and gastrointestinal tolerance in healthy term infants (n = 132/group) fed from 14 ± 3 days to 112 days of age. Data were classified and analyzed as evaluable (EV; subjects completing study per protocol) or intent-to-treat data (ITT; all subjects with available data). RESULTS Growth as indicated by weight gain (primary variable) and formula intake were not significantly different (p > 0.05) between feeding groups (EV or ITT). Though both formulas were well tolerated, spit-up frequency was significantly lower (p < 0.05) in the rice versus control group by 53% at 28 days of age, 54% at 56 days, 48% at 84 days, and 32% at 112 days (EV). Importantly, infants in the rice group were 1.6 to 1.8 times more likely to report zero spit-up than infants in the control group. The rice group also had higher percentages of soft and yellow stools. CONCLUSIONS The rice starch prethickened lactose-free milk protein-based formula (rice) supported normal growth and safe use as the sole source of feeding for normal infants over the first 4 months of life. The rice formula was efficacious in providing a clinically relevant reduction of spit-up frequency in otherwise healthy term infants.
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Epidemiology of food protein-induced enterocolitis syndrome.
Mehr, S, Frith, K, Campbell, DE
Current opinion in allergy and clinical immunology. 2014;(3):208-16
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Abstract
PURPOSE OF REVIEW To summarize the epidemiology of food protein-induced enterocolitis syndrome (FPIES). RECENT FINDINGS FPIES is regarded as a rare non-IgE-mediated gastrointestinal allergic disorder. Older nonpopulation-based studies reported an average of 1-15 cases presenting to allergy clinics a year, but recent studies have reported figures as high as 90 cases a year. The yearly incidence of FPIES in one Australian study was one in 10,000 infants less than 2 years of age. Chronic FPIES typically presents in neonates, whereas acute FPIES is primarily a disorder of young infants. FPIES has a slight male predominance; eczema and a family history of atopy are commonly present at diagnosis; almost one in 10 infants have coexistent IgE food allergies and siblings are rarely affected. There is regional variation in common triggering foods, rates of combined cow milk and soy FPIES and multiple food group FPIES. Understanding of the epidemiology of FPIES is limited by the lack of a universally accepted definition and the publication of few prospective population-based case series. SUMMARY FPIES is not as rare as once thought, but how common it is, what factors predispose to its development, and why there is regional variation needs to be addressed by future well designed population-based studies?
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Effects of dairy protein and fat on the metabolic syndrome and type 2 diabetes.
Bjørnshave, A, Hermansen, K
The review of diabetic studies : RDS. 2014;(2):153-66
Abstract
The incidence of the metabolic syndrome (MetS) and type 2 diabetes (T2D) is increasing worldwide. Evidence supports a negative relationship between the consumption of dairy products and risk of MetS and T2D. Dairy proteins are known to have a directly beneficial effect on hypertension, dyslipidemia, and hyperglycemia, but a detailed understanding of the underlying mechanisms is missing. It has been confirmed by observations that the insulinotropic effect of dairy proteins is associated with the amino acid composition; in particular branched-chain amino acids (BCAA) seem to be of vital importance. Dairy protein-derived peptides may also contribute to the insulinotropic effect via dipeptidyl peptidase-4 (DPP-4) inhibitory activity, and may lower the blood pressure (BP). The lipid metabolism may be improved by whey protein (WP), which acts to reduce the postprandial triglyceride (TG) response. The effect of dairy fat is much more controversial because of the potentially harmful effect exerted by saturated fatty acid (SFA) on metabolic health. Recent observations suggest less adverse effects of SFA on metabolic health than previous assumed. However, little is known about dairy lipid fractions belonging to the groups of monounsaturated fatty acids (MUFA), polyunsaturated fatty acids (PUFA), and phospholipids (PL). Dairy fat seems to act differently depending on the dairy product and the composition of macronutrients in the meal. Therefore, for a better understanding of the mechanisms behind the dairy protein and fat effect on MetS, we suggest that more human studies should be carried out to clarify the interactions of dairy protein and fat with macronutrients in the meal and other dairy components, such as micronutrients and microorganisms from fermented products.