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Growth of term infants fed a commercial infant formula with a protein content of 2.2 g/100 kcal: an observational follow-up study.
Jinno, S, Yamazaki, K, Nakamura, Y, Kinouchi, T
Bioscience, biotechnology, and biochemistry. 2020;(3):633-639
Abstract
To evaluate the suitability of the new nutritional composition of renewed commercial Formula A (protein reduced to 2.2 g/100 kcal, arachidonic acid increased to 13.2 mg/100 kcal, and docosahexaenoic acid maintained at 20 mg/100 kcal), we examined whether the growth of Formula A-fed infants was equivalent to that of breastfed infants. In this observational study, 1,053 infants were followed-up to 12 months. Growth, stool consistency, and the health condition of 99 infants fed with Formula A and 295 breastfed infants were compared. Body weight, body mass index, and head circumference of Formula A-fed infants were similar to those of breastfed infants. Additionally, there were no differences in the stool consistency and the health condition (infection and allergy prevalence) between the two groups. Formula A-fed infants grew as well as breastfed infants, suggesting the appropriate nutritional composition of Formula A. The findings may contribute to further improvements in infant formulas.
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Differences in energy expenditure in human donor milk versus formula milk in preterm newborns: A crossover study.
Soares, FVM, Abranches, AD, Méio, MDBB, Gomes, SC, Villela, LD, Moreira, MEL
Nutrition (Burbank, Los Angeles County, Calif.). 2019;:1-4
Abstract
OBJECTIVE The aim of this study was to compare the ratio between energy expenditure and caloric density in human donor milk versus formula milk in preterm newborn infants. METHODS This was a crossover, randomized clinical trial with 29 preterm newborn infants receiving full diet. The infants were randomly assigned to receive either human milk or formula milk alternating, after a 24-h period. Energy expenditure was evaluated by indirect calorimetry. Total calorie and macronutrient values in the human milk were calculated individually with infrared technique; energy expenditure/caloric density ratio was calculated. RESULTS Human donor milk energy expenditure/caloric density ratio was significantly greater than in formula milk at all time points. The total mean was 1.04 ± 0.27 for the human milk and 0.81 ± 0.11 for the formula. However, when we analyzed a subgroup of newborns that received human donor milk with >60 kcal/100 mL, there was no statistical difference (P = 0.36). The mean calorie values were 58.9 kcal/100 mL (human donor milk) and 81.4 kcal/100 mL (formula milk). CONCLUSION Formula milk produced a better metabolic response than human donor milk. Human donor milk with higher caloric content showed no difference from formula, so the use of human donor milk with more caloric density should be reinforced.
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Quantification of Nervonic Acid in Human Milk in the First 30 Days of Lactation: Influence of Lactation Stages and Comparison with Infant Formulae.
Yu, J, Yuan, T, Zhang, X, Jin, Q, Wei, W, Wang, X
Nutrients. 2019;(8)
Abstract
Nervonic acid (24:1 n-9, NA) plays a crucial role in the development of white matter, and it occurs naturally in human milk. This study aims to quantify NA in human milk at different lactation stages and compare it with the NA measured in infant formulae. With this information, optimal nutritional interventions for infants, especially newborns, can be determined. In this study, an absolute detection method that uses experimentally derived standard curves and methyl tricosanoate as the internal standard was developed to quantitively analyze NA concentration. The method was applied to the analysis of 224 human milk samples, which were collected over a period of 3-30 days postpartum from eight healthy Chinese mothers. The results show that the NA concentration was highest in colostrum (0.76 ± 0.23 mg/g fat) and significantly decreased (p < 0.001) in mature milk (0.20 ± 0.03 mg/g fat). During the first 10 days of lactation, the change in NA concentration was the most pronounced, decreasing by about 65%. Next, the NA contents in 181 commercial infant formulae from the Chinese market were compared. The NA content in most formulae was <16% of that found in colostrum and less than that found in mature human milk (p < 0.05). No significant difference (p > 0.05) was observed among NA content in formulae with different fat sources. Special attention was given to the variety of n-9 fatty acids in human milk during lactation, and the results indicated that interindividual variation in NA content may be primarily due to endogenous factors, with less influence from the maternal diet.
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Multiple functional gastrointestinal disorders are frequent in formula-fed infants and decrease their quality of life.
Bellaiche, M, Oozeer, R, Gerardi-Temporel, G, Faure, C, Vandenplas, Y
Acta paediatrica (Oslo, Norway : 1992). 2018;(7):1276-1282
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AIM: This prospective study evaluated the incidence of functional gastrointestinal disorders (FGIDs) during infancy, on their own or combined with other symptoms. METHODS We asked 273 French paediatricians with a specific interest in FGIDs to provide feedback on 2757 infants aged zero to six months from March 2013 to January 2014. Gastrointestinal health status was assessed by two questionnaires at inclusion and at a four-week follow-up visit. FGIDs were assessed according to the Rome III criteria and quality of life (QoL) was monitored. RESULTS Combined FGIDs were diagnosed in 2145 (78%) infants: 63% with two disorders and 15% with three or more disorders. The most frequently combined FGIDs were gas/bloating and colic (28%), colic and regurgitation (17.0%) and gas/bloating and regurgitation (8%). Compared to infants with a single FGID, combined FGID were associated with lower body weight (4.63 vs 4.79 kg, p = 0.009), shorter breastfeeding duration (33 vs 43 days, p < 0.001), a decreased QoL score (5.9 vs 6.5, p < 0.001), more frequent drug prescriptions (25% vs 13%, p < 0.001) and significantly greater improvements in QoL scores after four weeks (p = 0.003). CONCLUSION Combined FGIDs were extremely common in infants up to six months of age and had a negative impact on breastfeeding, weight gain and QoL.
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Reduction of Arachidonate Is Associated With Increase in B-Cell Activation Marker in Infants: A Randomized Trial.
Miklavcic, JJ, Larsen, BM, Mazurak, VC, Scalabrin, DM, MacDonald, IM, Shoemaker, GK, Casey, L, Van Aerde, JE, Clandinin, MT
Journal of pediatric gastroenterology and nutrition. 2017;(3):446-453
Abstract
BACKGROUND Infants who are not breast-fed benefit from formula with both docosahexaenoic acid (C22:6n3) and arachidonic acid (ARA; C20:4n6). The amount of ARA needed to support immune function is unknown. Infants who carry specific fatty acid desaturase (FADS) polymorphisms may require more dietary ARA to maintain adequate ARA status. OBJECTIVE The aim of the study was to determine whether ARA intake or FADS polymorphisms alter ARA levels of lymphocytes, plasma, and red blood cells in term infants fed infant formula. METHODS Infants (N = 89) were enrolled in this prospective, double-blind controlled study. Infants were randomized to consume formula containing 17 mg docosahexaenoic acid and 0, 25, or 34 mg ARA/100 kcal for 10 weeks. Fatty acid composition of plasma phosphatidylcholine and phosphatidylethanolamine, total fatty acids of lymphocytes and red blood cells, activation markers of lymphocytes, and polymorphisms in FADS1 and FADS2 were determined. RESULTS Lymphocyte ARA was higher in the 25-ARA formula group than in the 0- or 34-ARA groups. In plasma, 16:0/20:4 and 18:0/20:4 species of phosphatidylcholine and phosphatidylethanolamine were highest and 16:0/18:2 and 18:0/18:2 were lowest in the 34-ARA formula group. In minor allele carriers of FADS1 and FADS2, plasma ARA content was elevated only at the highest level of ARA consumed. B-cell activation marker CD54 was elevated in infants who consumed formula containing no ARA. CONCLUSIONS ARA level in plasma is reduced by low ARA consumption and by minor alleles in FADS. Dietary ARA may exert an immunoregulatory role on B-cell activation by decreasing 16:0/18:2 and 18:0/18:2 species of phospholipids. ARA intake from 25 to 34 mg/100 kcal is sufficient to maintain cell ARA level in infants across genotypes.
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Growth of Infants Fed Formula with Evolving Nutrition Composition: A Single-Arm Non-Inferiority Study.
Spalinger, J, Nydegger, A, Belli, D, Furlano, RI, Yan, J, Tanguy, J, Pecquet, S, Destaillats, F, Egli, D, Steenhout, P
Nutrients. 2017;(3)
Abstract
The nutritional composition of human milk evolves over the course of lactation, to match the changing needs of infants. This single-arm, non-inferiority study evaluated growth against the WHO standards in the first year of life, in infants consecutively fed four age-based formulas with compositions tailored to infants' nutritional needs during the 1st, 2nd, 3rd-6th, and 7th-12th months of age. Healthy full-term formula-fed infants (n = 32) were enrolled at ≤14 days of age and exclusively fed study formulas from enrollment, to the age of four months. Powdered study formulas were provided in single-serving capsules that were reconstituted using a dedicated automated preparation system, to ensure precise, hygienic preparation. The primary outcome was the weight-for-age z-score (WAZ) at the age of four months (vs. non-inferiority margin of -0.5 SD). Mean (95% CI) z-scores for the WAZ (0.12 (-0.15, 0.39)), as well as for the length-for-age (0.05 (-0.19, 0.30)), weight-for-length (0.16 (-0.16, 0.48)), BMI-for-age (0.11 (-0.20, 0.43)), and head circumferencefor-age (0.41 (0.16, 0.65)) at the age of four months, were non-inferior. Throughout the study, anthropometric z-scores tracked closely against the WHO standards (within ±1 SD). In sum, a fourstage, age-based infant formula system with nutritional compositions tailored to infants' evolving needs, supports healthy growth consistent with WHO standards, for the first year of life.
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Follow-up of a randomized trial on postdischarge nutrition in preterm-born children at age 8 y.
Ruys, CA, van de Lagemaat, M, Finken, MJ, Lafeber, HN
The American journal of clinical nutrition. 2017;(2):549-558
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Background: Early nutritional interventions may modulate health risks in preterm-born infants. Previously, we showed that preterm-born infants fed an isocaloric protein- and mineral-enriched postdischarge formula (PDF) from term age to 6-mo corrected age (CA) gained more lean mass than did those fed term formula (TF). Long-term follow-up of randomized nutritional trials is important to test the hypothesis that short-term positive effects on health are sustainable.Objective: The aim of this follow-up study was to compare body size, body composition, and metabolic health at age 8 y in preterm-born children who were randomly assigned to receive either PDF or TF from term age until 6-mo CA.Design: A total of 79 of 152 children (52%) from the original randomized controlled trial were enrolled for follow-up at age 8 y. Weight, height, and head circumference were measured by using standard methods. Body composition, including fat mass, lean mass, bone mineral content, and bone mineral density, was determined by dual-energy X-ray absorptiometry. Blood pressure was measured in the supine position by using an automatic device. Metabolic variables, including glucose, insulin, insulin-like growth factor I, triglycerides, cholesterol, cortisol, and leptin, were measured after an overnight fast. Nutritional habits at age 8 y were assessed by using a 3-d nutritional diary.Results: At age 8 y, no differences were found in body size, body composition, bone variables, and metabolic health variables when comparing children fed PDF with those fed TF. Adjustment for known and possible confounders did not change these results.Conclusions: In this follow-up study in preterm-born children, we showed that the favorable effects of PDF at 6-mo CA either were not maintained or could not be confirmed because of attrition at the age of 8 y. We suggest that future research should focus on nutritional interventions in the pre- and postdischarge period as a continuum rather than as separate entities. This trial was registered at www.trialregister.nl as NTR 2972 (follow-up study [STEP-2 (Study Towards the Effects of Post-discharge Nutrition 2)]) and NTR 55 [original randomized controlled trial (STEP)].
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Sexually dimorphic response to feeding mode in the growth of infants.
Cheng, TS, Loy, SL, Cheung, YB, Chan, JK, Pang, WW, Godfrey, KM, Gluckman, PD, Kwek, K, Saw, SM, Chong, YS, et al
The American journal of clinical nutrition. 2016;(2):398-405
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BACKGROUND The relation between infant feeding and growth has been extensively evaluated, but studies examining sex differences in the influence of infant milk feeding on growth are limited. OBJECTIVE We examined the interaction of infant feeding and sex in relation to infant growth and compared growth trajectories in breastfed and formula-fed boys and girls. DESIGN In 932 infants in a Singapore mother-offspring cohort, feeding practices in the first 6 mo were classified into the breastfeeding group (BF), mixed feeding group (MF), and formula feeding group (FF). Infant weight and length were measured and converted to WHO standards for weight-for-age z scores (WAZs) and length-for-age z scores (LAZs). Differences in WAZ and LAZ from birth to 6 mo, 6 to 12 mo, and 12 to 24 mo of age were calculated. Three-way interactions were examined between feeding mode, sex, and age intervals for WAZ and LAZ changes, with adjustment for confounders. RESULTS The interaction between feeding mode, sex, and age intervals was significant for LAZ changes (P = 0.003) but not WAZ changes (P = 0.103) after adjustment for potential confounders. Compared with BF girls, BF boys showed similar LAZ gain (+0.28 compared with +0.39, P = 0.544) from 0 to 6 mo of age but greater LAZ gain from 6 to 12 mo of age (+0.39 compared with -0.10, P = 0.008). From 0 to 6 mo of age, FF boys and girls showed greater LAZ gains than their BF counterparts; from 6 to 12 mo of age, FF girls showed higher LAZ gain (+0.25 compared with -0.10, P = 0.031) than BF girls, which was not seen in boys. CONCLUSIONS During infancy, there is a sexually dimorphic growth response to the mode of infant milk feeding, raising questions about whether formula feeding ought to remain sex neutral. However, further investigations on sex-specific feeding and infant growth are warranted before a conclusive message can be drawn based on our current findings. This trial was registered at www.clinicaltrials.gov as NCT01174875.
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Association of early protein intake and pre-peritoneal fat at five years of age: Follow-up of a randomized clinical trial.
Gruszfeld, D, Weber, M, Gradowska, K, Socha, P, Grote, V, Xhonneux, A, Dain, E, Verduci, E, Riva, E, Closa-Monasterolo, R, et al
Nutrition, metabolism, and cardiovascular diseases : NMCD. 2016;(9):824-32
Abstract
BACKGROUND AND AIMS The double-blind randomized European Childhood Obesity Project (CHOP) demonstrated that reduced protein content in infant formula leads to a lower body mass index (BMI) up to six years of age. Here we aimed at assessing pre-peritoneal fat, a marker of visceral fat, in children participating in the CHOP trial. METHODS AND RESULTS Healthy term formula-fed infants in five European countries were randomized either to higher (n = 550) or lower (n = 540) protein formulas in the first year of life. Infants who were exclusively breastfed for at least three months (n = 588) were enrolled as an observational (non randomized) group. At age 5 years, subcutaneous fat (SC) and pre-peritoneal fat (PP) were measured by ultrasound in a subgroup of 275 children. The PP fat layer was thicker in the higher compared to the lower protein group (adjusted estimated difference: 0.058 cm, 95%CI 0.002; 0.115; p = 0.043), while SC fat was not different. Girls showed a thicker SC fat layer than boys. CONCLUSIONS Higher protein intake in formula-fed infants appears to enhance pre-peritoneal fat tissue accumulation at the age of 5 years, but not of subcutaneous fat, which may trigger adverse metabolic and health consequences.
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Limited Amount of Formula May Facilitate Breastfeeding: Randomized, Controlled Trial to Compare Standard Clinical Practice versus Limited Supplemental Feeding.
Straňák, Z, Feyereislova, S, Černá, M, Kollárová, J, Feyereisl, J
PloS one. 2016;(2):e0150053
Abstract
OBJECTIVES Breastfeeding is known to reduce infant morbidity and improve well-being. Nevertheless, breastfeeding rates remain low despite public health efforts. Our study aims to investigate the effect of controlled limited formula usage during birth hospitalisation on breastfeeding, using the primary hypothesis that early limited formula feeds in infants with early weight loss will not adversely affect the rate of exclusive or any breastfeeding as measured at discharge, 3 and 6 months of age. MATERIAL AND METHODS We randomly assigned 104 healthy term infants, 24 to 48 hours old, with ≥ 5% loss of birth weight to controlled limited formula (CLF) intervention (10 ml formula by syringe after each breastfeeding, discontinued at onset of lactation) or control group (standard approach, SA). Groups were compared for demographic data and breastfeeding rates at discharge, 3 months and 6 months of age (p-values adjusted for multiple testing). RESULTS Fifty newborns were analysed in CLF and 50 in SA group. There were no differences in demographic data or clinical characteristics between groups. We found no evidence of difference between treatment groups in the rates of exclusive as well as any breastfeeding at discharge (p-value 0.2 and >0.99 respectively), 3 months (p-value 0.12 and 0.10) and 6 months of infants' age (p-value 0.45 and 0.34 respectively). The percentage weight loss during hospitalisation was significantly higher in the SA group (7.3% in CLF group, 8.4% in SA group, p = 0.002). CONCLUSION The study shows that controlled limited formula use does not have an adverse effect on rates of breastfeeding in the short and long term. Larger studies are needed to confirm a possible potential in controlled limited formula use to support establishing breastfeeding and to help to improve the rates of breastfeeding overall. TRIAL REGISTRATION ISRCTN registry ISRCTN61915183.