Milk Formula Research Articles

Feeding Precarity Between State and Capital: Women Workers and Breastfeeding in Cakung Manufacturing Industry

Women constitute the vital workforce in Indonesia's economy, particularly in sectors like garment, textile, and footwear. Despite their economic importance, these industries are characterised by excessive control, pressure, and violence, transforming women into cheap labour and limiting their lives both in the production and social reproduction realm. This study analyses how the discipline of factory work has implications for women workers in their care work, specifically in breastfeeding. Through a qualitative approach, this study uses focus group discussions (FGD) and interviews with women garment and textile industry workers in Kawasan Berikat Nusantara, North Jakarta. The study also analyses the state's response and position in child-feeding matters. The study shows how the regimented nature of factory work, which controls the energy, time, and bodies of women workers, coupled with the absence of job security and protection from the state, limit workers’ capacity to care for their families, particularly to breastfeed their children. Consequently, women workers have to switch to formula milk. I argue that the workers’ reliance on formula milk illustrates a form of neoliberalism in which the state subjugates women workers to the capitalist economy both in the realms of production and social reproduction, forcing them to live in a precarious condition. This potentially will cause health, nutrition, and other quality of life problems for mothers and children in the future.

Analytical advances in the determinations of dietary sphingolipids in milk, dairy products, and infant formula and impacts on human health

SummarySphingolipids (SL) are bioactive compounds in milk, dairy products, and infant formula. SL has been found to have different health benefits, such as anti‐inflammatory, antimicrobial, anticancer, and cholesterol‐lowering characteristics. SL requires careful extraction, separation, and identification due to their unique characteristics. This review discusses the importance of extracting, purifying, and analysing SL from milk and dairy products. OE (Organic extraction), SPE (solid‐phase extraction), and SFE (supercritical CO2) techniques, as well as dispersive OE and SPE, are the most common methods. In addition, this review discussed various analytical techniques that can be used to determine and quantify SL classes, including TLC (thin‐layer chromatography), HPLC (high‐performance liquid chromatography), nuclear magnetic resonance spectroscopy, and mass spectrometry. These techniques are crucial for understanding the amounts of SL dairy products and infant formula. The paper also focuses on the different types of SL present in milk, dairy products, and infant formula and their concentrations. SL has the potential to be applied to the development of functional foods, and further research in this area is needed. This article sheds light on the extract, purification, and analysis of SL dairy products and infant formula, as well as their potential health benefits.

Violations of Vietnamese laws related to the online marketing of breastmilk substitutes: Detections using a virtual violations detector.

Breastfeeding rates in Vietnam, and globally, remain suboptimal. A major contributor to this is the aggressive marketing of commercial milk formulas (CMF), mainly through online media. The Vietnamese Government has implemented legal measures to limit CMF marketing, but these have been difficult to enforce, because of complex online environments. We aimed to quantify the extent and nature of online violations and contradictions in various Vietnamese laws related CMF marketing over 12 months in 2022. Using a cross-sectional study design, we used an artificial intelligence-enabled virtual violations detector (VIVID) to monitor official websites and social media pages of 25 breastmilk substitute (BMS) merchandise and distributors, every day for 12 months in 2022. Data were summarised descriptively. We detected more than 3000 online advertisements that violated or contradicted the intent of Vietnamese laws, involving almost 7000 violations of various articles within these laws (average 9.5 violations per day). More than 700 detections were related to CMF products being registered as "supplementary foods" or similar, thereby circumventing Vietnamese CMF marketing laws, because they are not registered as "BMS products. We demonstrate the need to strengthen the design, monitoring and enforcement of existing Vietnamese laws to eliminate mothers" exposure to the exploitative digital marketing of CMF. By turning a highly resource-intensive task into one that is, automatedrequiring substantially less resources, our study represents the most comprehensive in Vietnam and internationally on the extent and nature of the online marketing of BMS. VIVID can be applied worldwide to hold industry accountable for the inappropriate marketing of CMF.

Tailored recommendations for infant milk formula intake results in more accurate feeding.

Based on theoretical calculations and actual formula intake data, we conclude that larger infants require a significantly higher daily formula milk intake than smaller infants, and we postulate that infants could benefit from more tailored formula milk intake recommendations. • Adequate energy intake during the infancy period is crucial to support optimal growth and organ development, with the potential for long-lasting health effects. • Current available guidelines on the daily formula milk requirements of infants are based on the needs of infants with their growth pattern following the 50th percentile of the weight-for-age growth curve. • Based on using both theoretical calculations and actual formula intake data, larger infants require a significantly higher daily formula milk intake than smaller infants. • Exclusive formula-fed infants could benefit from more tailored formula milk intake recommendations, in early infancy.

Transcriptome and metabolome analyses reveal the effects of formula and breast milk on the growth and development of human small intestinal organoids

Breast milk is widely acknowledged as the ideal nutritional resource for infants and can well meet the nutritional requirements for baby’s growth and development. Infant formula is a substitute for breast milk, designed to closely mimic its composition and function for breast milk. Most of the previous studies used tumor colorectal cancer cell lines to study the nutritional potency of formula and its components, so realistic data closer to the baby could not be obtained. Small intestinal organoids, derived from differentiated human embryonic stem cells, can be used to simulate nutrient absorption and metabolism in vitro. In this experiment, we used small intestinal organoids to compare the nutrient absorption and metabolism of three infant formulae for 0–6 months with breast milk samples. Transcriptome and metabolome sequencing methods were used to analyze the differentially expressed genes (DEGs) and differentially expressed metabolites (DEMs). The pathways related to DEGs, DEMs were enriched using GO, KEGG, GSEA and other methods to investigate their biological characteristics. We have found that both formula and breast milk promote the development of the infant’s immune system, nutrient absorption and intestinal development. In PMH1 we found that the addition of oligofructose to milk powder promoted lipid metabolism and absorption. In PMH2 we found that whey protein powder favours the development of the immune system in infants. In PMH3 we found that oligogalactans may act on the brain-gut axis by regulating the intestinal flora, thereby promoting axon formation and neural development. By linking these biological properties of the milk powder with its composition, we confirmed the effects of added ingredients on the growth and development of infants. Also, we demonstrated the validity of small intestine organoids as a model for absorption and digestion in vitro. Through the above analyses, the advantages and disadvantages of the roles of formula and breast milk in the growth and metabolism of infants were also compared.

Health risk assessment of potentially toxic elements in minerals-fortified milk and young child formula in Brazil

Exposure to potentially toxic elements above certain limits can cause adverse effects on human health, with young children being the most vulnerable. Then, the aim of this study was to determine, by inductively coupled plasma mass spectrometry (ICP-MS), the concentration of potentially toxic elements (Al, As, Cd, Hg, Ni, Pb, Sn, Ti, and U) in minerals-fortified milk (MFM) and young child formula (YCF) commercialized in Brazil and recommended for children aged 1–3 years. High concentrations (mg kg−1) were found in MFM and YCF, respectively, for Ti (21.1–23.7 and 8.62–25.7), Al (0.59–4.69 and 0.23–4.92), and Ni (0.66–2.89 and 1.09–1.59). Total As concentrations varied from 0.02 to 0.07 mg kg−1, Pb, Sn, Cd, and U were present at low concentrations and Hg was not detected in any sample. The target hazard quotient (THQ) and the target carcinogenic risk (TCR) were also determined, and almost all the THQ values were found below 1, except for Ni, indicating potential risk to children in two of the brands analyzed. The concentrations determined for total As were worrying because, if it was inorganic form, all analyzed samples would represent health and cancer risk, indicating the urgent need for updated protocols for As speciation and food monitoring in the Brazilian market. Thus, controlling the processing and increasing the monitoring of these products is essential to avoid adverse effects on children’s health in the short and long term.

Iron Absorption from an Iron-Fortified Follow-Up Formula with and without the Addition of a Synbiotic or a Human-Identical Milk Oligosaccharide: A Randomized Crossover Stable Isotope Study in Young Thai Children

BackgroundPrevious studies showed that pre- and probiotics may enhance iron absorption. Probiotics combined with prebiotics (synbiotics), including human-identical milk oligosaccharides (HiMOs), are commonly added to infant and follow-up formula (FUF). Whether these additions enhance iron absorption from iron-fortified commercial milk formula is uncertain. ObjectivesWe determined the effect of adding 1) a synbiotic [galacto-oligosaccharide [GOS] + Limosilactobacillus reuteri (L. reuteri)] or 2) the HiMO 2′-fucosyllactose (2′FL) to iron-fortified FUF on iron absorption in young Thai children. MethodsIn a randomized, controlled, single-blinded (participants) crossover study, 82 Thai children aged 8–14 mo were enrolled to consume single servings (235 mL) of FUF with isotopically labeled ferrous sulfate (2.2 mg iron) with 1) the synbiotic (400 mg/100 mL GOS and L. reuteri DSM 17938), 2) the HiMO 2′FL (100 mg/100 mL), and 3) without synbiotic and 2′FL (control) in random order and a 3-d washout period between administrations. Fractional iron absorption [FIA (%)] was assessed by measuring erythrocyte incorporation of isotopic labels 14 d (n = 26) and 28 d (n = 76) after consumption of the last test FUF. ResultsMedian (IQR) FIA from iron-fortified FUF with the synbiotic [8.2 (5.2, 12.9)%] and with 2′FL [8.4 (5.5, 14.1)%] did not differ from the control FUF [8.1 (4.8,14.7)%] (synbiotic compared with control, P = 0.24; 2′FL compared with control, P = 0.95). FIA from all FUF did not differ when measured after 14 and 28 d of erythrocyte incorporation (Time, P = 0.368; FUF, P = 0.435; Time × FUF, P = 0.937). Fecal pH and hemoglobin were negatively associated with FIA. ConclusionsIn young Thai children, the addition of a synbiotic (GOS + L. reuteri) or 2′FL to iron-fortified FUF did not impact FIA from a single serving.The study was registered at clinicaltrials.gov as NCT04774016.

Awareness about Neonatal Lactose Intolerance among Chinese Neonatologists in Outpatient Settings: A Multi-Center Survey.

This study aimed to identify the specific areas of knowledge gaps regarding lactose intolerance among neonatologists in Chinese outpatient settings as well as to assess the availability of lactose intolerance testing in hospitals. A total of 278 neonatologists in outpatient settings from 144 hospitals were surveyed. To explore the awareness level, diagnosis, and treatment of neonatal lactose intolerance among neonatologists in outpatient settings, a multicenter cross-sectional survey was designed. Descriptive analysis based on frequency and percent distribution was performed for all variables. Most respondents were senior doctors (256, 92.09%) from general hospitals and maternity/maternal and child health hospitals, had over 10 years of experience, and were dominantly associate chief physicians and chief physicians (211, 75.90%). A significant proportion of the participants (236, 84.89%) believed that neonatal lactose intolerance tends to be overlooked during clinical practice. When the most common symptoms of neonatal lactose intolerance were surveyed, diarrhea was selected by 142 (51.08%) respondents, followed by bloating and milk regurgitation or emesis (71, 25.54%). Other symptoms included unexplained crying (36, 12.85%), stool with milk flap or foam (15, 5.40%), and increased venting (14, 5.04%). Furthermore, the survey results indicated that the most common method for diagnosing neonatal lactose intolerance in the respondents' hospitals was qualitative test for urinary galactose (78, 28.06%). Of the respondents, 137 (49.28%) stated that their hospital could not test for lactose intolerance. For treating lactose intolerance, the neonatologists primarily opted for exogenous lactase rather than lactose-free formula milk. This study sheds light on Chinese neonatologists' awareness of neonatal lactose intolerance, revealing some knowledge gaps. The expeditious popularization and conduct of lactose intolerance-related examinations in hospitals will have a positive stimulative effect on the management of lactose intolerance in newborns.

Toxic risk assessment of selected metals in infant formula milk commercially available in Lebanon: A novel approach based on feeding parameters versus toxicity

Infant formula milk (IFM) is increasingly utilized as a substitute for natural breastfeeding despite the fact that breast milk has been always recognized as the optimal nourishment method. While IFMs are fortified with essential nutrients that are crucial for proper growth, they can also harbor non-essential toxic metal contaminants from various sources during the production process. Given the heightened vulnerability of newborns to such contaminants, it is imperative to thoroughly analyze, evaluate, and minimize the toxicity associated with the consumption of such IFMs. However, classical approaches to date, have been always adopted for assessing such risks by finding first the analytical concentration of metals in the IFMs followed by multiplying it by the average daily powder intake (ADI) then dividing by the average infant weight. The outcome is then compared to an established standard such a PTWI to assess the extent of toxicity. The drawback with such studies is the use of a fixed ADI for all samples as if all samples have the same and exact preparation directions while using somewhat different infant masses.Accordingly, this study aims at assessing the toxic risk amongst newborns from IFM consumption through the identification and application of various highly important and toxicity-contributing parameters from each IFM and its directions of preparation label separately which are discussed here for the first time while providing comparisons between the classical approach versus our new approach to highlight its importance.Seventy-three IFMs (0–6 months) were analyzed for lead (Pb), cadmium (Cd), arsenic (As), and aluminum (Al) levels and unlike previous studies, this work incorporated various feeding parameters from each IFM for calculating the intakes thus, revealing potential toxicity risks even in IFMs that are considered safe by the classical approach. Metal contamination was significant, with 97.3 % of samples containing detectable Pb, 41.1 % Cd, 16.4 % As, and 93.2 % Al while highlighting Pb in exceeding its maximum allowable level (MAL). This novel approach, which considers new diverse feeding schedules/parameters that are ironically suggested by manufacturers that have been previously overlooked elsewhere, emphasized IFMs' potential as sources of heightened metal toxicity in comparison to classical approaches. Results highlighted Pb and Al as major concerns, with As and Cd of lesser concern. Findings also emphasized the importance of such new parameters for safeguarding newborn health and should be payed attention to by caregivers. The study strongly and highly recommends adherence to minimum feeding schedules (MFS) and proper scooping techniques to reduce newborn exposure to toxic metals. It also suggests continuous monitoring and stricter regulations by health authorities at the production level of such products so as to provide a safer commodity in the first degree and to also provide better and somewhat uniform and specific feeding labels and precautions on such products.

Views on wet nursing and expressing breastmilk for sharing and human milk bank donation among mothers in two parenting social media communities in Vietnam.

Nutrition in early life plays a key role in shaping an infant's future health. There is limited understanding of the perspectives of Vietnamese mothers with children under 24 months of age regarding breastmilk expression, donationand use. In this cross-sectional study, an online survey was administered through two parenting social media communities to assess opinions on breastmilk expression, breastmilk donation including contributions from bereaved mothersand the use of donor human milk. A 4-point Likert scale was used to evaluate respondents' opinions, and demographic and breastfeeding information was collected. Among 375 respondents, almost 30% had received breastmilk from another woman, either through direct breastfeeding (14.7%), expressed breastmilk (12.5%)or from a human milk bank (2.7%). In this survey of 375 mothers, 84.0% indicated they would store excess breastmilk, while 75.7% and 69.6% would donate to a human milk bank or another mother, respectively. When faced with insufficient breastmilk, 88.5% of mothers would seek ways to increase supply, whereas 23.8% considered using commercial milk formula. Regarding milk expression among the 375 mothers, 78.4% preferred electric pumps, compared to 48.6% for manual pumps and 45.9% for hand expression. Additionally, 80.5% of the 375 mothers would suggest donating stored milk to bereaved peersand 85.6% would suggest mothers with mild COVID-19 to continue breastfeeding with precautions. These findings indicate that this sample has positive views on breastfeeding, breastmilk donationand the use of donor human milk.

An A2 β-casein infant formula with high sn-2 palmitate and casein phosphopeptides supports adequate growth, improved stool consistency, and bone strength in healthy, term Chinese infants: a randomized, double-blind, controlled clinical trial.

The aim of this randomized, double-blind, controlled trial was to examine the effects of infant formula on the growth, stool consistency, and bone strength of infants (n = 120) over a period of 4 months. The investigational group was fed an A2 β-casein cow's milk infant formula containing casein phosphopeptides (CPP) and high sn-2 palmitate (54% of total palmitate at sn-2). The control group was fed a standard cow's milk formula without CPP and with low sn-2 palmitate (29% of total palmitate at sn-2). The third group was fed human milk (HM) (n = 60). All three groups had similar baseline characteristics, and maintained similar BMI, sleep habits, and growth rates in body weight and length throughout the study. However, compared to the control group, infants in the investigational and human milk groups had significantly: (i) greater body length at 90, 120, and 150 days of age; (ii) greater growth rate in head circumference from 30 to 60 days of age, with larger head circumference at 60 days of age; (iii) larger daily stool frequency at 60, 90, and 120 days of age; (iv) softer stool at 60, 90, and 120 days of age; (v) higher bone quality index and bone speed of sound at 150 days of age; (vi) fewer hours of crying at 60 and 90 days of age; (vii) less abdominal distention, burp, and flatus at 60, 90, and 120 days of age; and (viii) less constipation at 90 days of age. At other time points, no significant differences were observed between the three groups. No serious adverse events (AEs) related to the study products were reported, and significantly fewer infants in the investigational and HM groups experienced at least one AE compared to the control group. The study suggests that the A2 β-casein formula with high sn-2 palmitate and CPP supports adequate growth, is well tolerated, and may have beneficial effects on stool consistency, gastrointestinal comfort, crying duration, and bone density, comparable to HM. Clinical trial registration: https://clinicaltrials.gov/, NCT04749290.

Political Economy of Maternal Child Malnutrition: Experiences about Water, Food, and Nutrition Policies in Pakistan.

This study examined access to water, food, and nutrition programs among marginalized communities in Southern Punjab, Pakistan, and their effects on nutrition. Both qualitative and quantitative data were used in this study. We held two focus group discussions (one with 10 males and one with 10 females) and conducted in-depth interviews with 15 key stakeholders, including 20 mothers and 10 healthcare providers. A survey of 235 households was carried out to evaluate water and food insecurity, with the data analyzed using Wilcoxon's rank-sum test, t-test, and Pearson's chi-square test. The results revealed that 90% of households experienced moderate-to-severe water insecurity, and 73% faced moderate-to-severe food insecurity. Household water and food insecurity were positively correlated with each other (correlation coefficient = 0.205; p = 0.004). Greater household water (p = 0.028) and food insecurity (p < 0.001) were both associated with higher perceived stress. Furthermore, lower socioeconomic status was strongly related to higher levels of water (p < 0.001) and food insecurity (p < 0.001). Qualitative findings highlight the impact of colonial and post-colonial policies, which have resulted in water injustice, supply issues, and corruption in water administration. Women face significant challenges in fetching water, including stigma, harassment, and gender vulnerabilities, leading to conflicts and injuries. Water scarcity and poor quality adversely affect sanitation, hygiene, and breastfeeding practices among lactating mothers. Structural adjustment policies have exacerbated inflation and reduced purchasing power. Respondents reported a widespread lack of dietary diversity and food quality. Nutrition programs face obstacles such as the exclusion of people with low social and cultural capital, underfunding, weak monitoring, health sector corruption, and the influence of formula milk companies allied with the medical community and bureaucracy. This study concludes that addressing the macro-political and economic causes of undernutrition should be prioritized to improve nutrition security in Pakistan.

Financial Feasibility of Service-Based Business

In Indonesia, over 6,300,000 toddlers are affected by stunting. Research indicates that the prevalence of stunting among children of working mothers is 30.6%. Despite the associated health risks, many working mothers prefer formula milk as a substitute for breast milk. Mengasihi, a health technology start-up providing breast milk powdering services for personal use, aims to offer babies a simple and effective nutritional solution. This study investigates the financial feasibility of Mengasihi as an early-stage start-up. It was found that cash flow plays a crucial role in start-up failure, impacting long-term organizational success. A feasibility study assessed Mengasihi's financial viability, analyzing internal and external financial conditions using criteria such as Payback Period, Net Present Value (NPV), and Internal Rate of Return (IRR) based on five-year financial projections. The results indicate that the Mengasihi project is financially viable, and an implementation plan was provided as part of the study.

A Review: Development of a Synthetic Lactoferrin Biological System.

Lactoferrin is an iron-binding glycoprotein with antibacterial, antitumor, and immunomodulatory functions derived from milk and mucosal secretions. Lactoferrin is used in various products, such as infant formula milk powder, nutritional supplements, and cosmetics. Researchers have developed new technologies to produce lactoferrin because there are limitations in the separation and purification of lactoferrin from milk that cannot compensate for the market demand. Therefore, synthetic systems of lactoferrin have been developed with the development of genetic engineering, and the structure of lactoferrin expressed in heterologous systems is very similar to that of natural lactoferrin. The structure and functions of lactoferrin and the design and construction of synthetic lactoferrin biological systems, especially microbial synthetic systems, including prokaryotic and eukaryotic host-expression systems, are described. On the basis of these results, we summarize the challenges and solutions for constructing systems of high-yield lactoferrin. The development directions of recombinant lactoferrin are discussed in this review. Overall, the design and development of these synthetic biological systems have allowed us to explore the great potential of the industrial large-scale preparation of lactoferrin.

The effect of exclusive breastfeeding on synaptogenesis and cell survival in mouse offspring

The first thousand days of life are critical for determining a child's cognitive development in humans. Breastfeeding may provide the nutrients needed for brain development. Cognitive function has been widely associated with neuronal turnover, driven by synaptogenesis and apoptosis. To explore this hypothesis, this study aimed to examine the effect of exclusive breastfeeding (EBF) on cognitive function and neuronal turnover in the dentate gyrus of the mice hippocampus. We conducted cognitive function assessments using the Morris Water Maze (MWM) test. We also examined neuronal apoptosis with TUNEL assay and synaptogenesis using PSD-95 antibodies. The newborn mice (mixed gender) aged 0 days were randomly divided into two groups. The first group received exclusive breastfeeding (EBF, n = 14), while the second group (MF, n = 14) received mixed breast milk and formula milk. At postnatal day 21 (PND21), the MWM test was performed, followed by an assessment of neuronal apoptosis and synaptogenesis. In the MWM test, the escape latency of the EBF group was shorter than the MF group. There was a significant increase in PSD-95 expression and a decrease in TUNEL expression in the EBF group (p &lt; 0.001) than in the MF group. In conclusion, exclusive breastfeeding is associated with higher cognitive function. Exclusive breastfeeding affects neuronal turnover by increasing synaptogenesis and decreasing apoptosis in the dentate gyrus of the hippocampus. This has both scientific and clinical implications, pointing to nutritional practices early in life that could optimise the attainment of cognitive potential.

Breastfeeding in PKU and Other Amino Acid Metabolism Disorders-A Single Centre Experience.

In addition to the numerous immunological and nutritional benefits that breast milk offers to infants, its proportion in the diet must be limited or even excluded in the case of inborn errors of amino acid metabolism (IEM). The objective of the study was to expand knowledge about breastfeeding and the degree of contribution of breast milk to the feeding of infants with IEM before and after the introduction of expanded newborn screening. A retrospective single-centre study was conducted on 127 infants born between 1997 and 2020: 66 with phenylketonuria (PKU), 45 with other IEM (non-PKU), all diagnosed through newborn screening (NBS), and 16 non-PKU diagnosed through selective screening (SS). The time of initiation of dietary treatment and the proportion of breast milk in the diet, both expressed and breastfed, with or without intake control, were analysed at 1, 3, and 6 months after birth. For 47% of the newborns in Groups 1 and 2, the dietary treatment was started before the 10th day of life; in Group 3, the dietary treatment was started after the 10th day of life for all children. During the first month of life, the proportion of infants receiving breast milk was higher in the NBS-PKU (74%) and the NBS non-PKU (80%) groups, compared with 38% in the SS non-PKU infants. In the subsequent months of life, the proportion of infants receiving human milk (either from the breast or a bottle) declined in all groups. This decline occurred more in bottle-fed rather than directly breast-fed infants. Our observations indicate that the model of feeding from a bottle with expressed milk may have had an adverse effect on maintaining lactation and may have contributed to a faster transition to formula milk. Maintaining lactation and extending the period of feeding the infant with human milk in the first 6 months of life is possible by breastfeeding on demand, under regular biochemical monitoring: preferably weekly in PKU infants, and at least every 2-4 weeks in infants with other IEM.

The efficacy of low/lactose-free milk powder in the treatment of lactose intolerance in infants: A protocol for systematic review and meta analysis.

The aim of this study was to evaluate the efficacy and safety of formula milk powder in the treatment of lactose intolerance in children, and to provide an evidence-based medicine basis for the rational use of drugs in children with lactose intolerance caused by various reasons by meta-analysis. Use computers to search major databases, including Web of Science, PubMed, CNKI, Wanfang Data Knowledge Service Platform, and other databases, the retrieval time is from the establishment of the database to April 2023. The collected literatures were screened, data extracted and processed, and then meta-analysis was performed by Review-Manager 5.4 statistical software. A total of 10 randomized controlled trials were included, with 1112 patients, including 562 patients in the treatment group and 550 patients in the control group. The control group was treated with conventional therapy, and the treatment group was treated with lactose-free/low-lactose milk powder on the basis of conventional therapy. The results of the meta-analysis showed that the clinical efficacy of the treatment group was significantly better than that of the control group [odds ratio=6.01, 95% confidence interval (CI): 3.94-9.18, P<0.00001], the course of disease in the treatment group was shorter than that in the control group (mean difference=-1.45, 95% CI: -1.76 to -1.13, P<0.0001). The antidiarrhea time of the treatment group was shorter than that of the control group, and the difference between the 2 groups was statistically significant (mean difference=-1.41, 95% CI: -1.67 to -1.15, P<0.0001). Low/lactose-free milk powder can improve clinical efficacy and shorten the course of treatment in infants with lactose intolerance, which can be demonstrated by further large-scale clinical studies.

Formulation optimization of a probiotic low-calorie chocolate milk and investigating its qualitative properties during storage

Due to concern regarding the consumption of high amount of sugar in diet and role of diet in combating overweigh and related disease, the aim of present study was to optimize a reduced calorie probiotic chocolate milk formula with suitable physicochemical properties. The formula comprising inulin, stevia (Stevia rebaudiana Bertoni), chia (Salvia hispanica L.) seed gum (CSG), and whey protein concentrate (WPC) which optimized using Box-Behnken design (BBD) and then enriched with an encapsulated probiotic strain Lactobacillus acidophilus (DSM1643). The independent variables included inulin (2–8%), CSG (0.1–0.5 %), stevia (50–100 % replacement of sugar), and WPC (1–3%). The dependent variables were selected as viscosity, average particle size, sedimentation percentage, and general acceptance. Optimization done toward achieving the highest viscosity and general acceptance and the lowest sedimentation percentage and average particle size. The optimal conditions were found to be 7.99 % inulin, 70 % stevia, 0.34 % CSG, and 1 % WPC. Under these conditions, the viscosity, sedimentation percentage, average particle size, and general acceptance of the product were equal to 40.69 mPa s, 2.2 %, 434.221 nm, and 5.1, respectively. Next, the chocolate milk was enriched with at 109 CFU/g probiotic bacteria and evaluated. The probiotic strain was resistant to simulated gastrointestinal conditions and under this condition the free bacterial cells count declined by 8 logCFU/g while the encapsulated cells decreased approximate 3 logCFU/g. The bacteria count did not undergo a significant change until the 5th day of storage. The results showed that the inulin, stevia, CSG, and WPC at optimal concentrations and encapsulated probiotic bacteria could be simultaneously applied to produce a product with good properties. This formula could be considered as a new product with health improving properties, low calorie which is suitable for people suffering from diabetes and obesity.

'It's far from the norm': breastfeeding beyond 1 year in the Republic of Ireland.

Breastfeeding is the optimal form of nutrition for infants and young children. The World Health Organization recommends that babies are breastfed exclusively for the first 6 months of life, and up to the age of 2 years or beyond in combination with complementary food. Breastfeeding initiation and continuation rates are suboptimal globally and very low in the Republic of Ireland where health promotion initiatives and healthcare professional support predominantly focus on the important phase of initiation and early months of the breastfeeding journey. This qualitative descriptive study aimed to explore the experiences of women who chose to breastfeed their children beyond 1 year of age in the Republic of Ireland. Fourteen women participated in semi-structured interviews. Interviews were transcribed verbatim and thematic analysis was conducted. The analysis generated three overarching themes: (1) Influences on breastfeeding beyond 1 year, (2) Sustaining breastfeeding and (3) Benefits of breastfeeding beyond 1 year. Family, friends, peers, culture and commercial milk formula marketing had an influence on breastfeeding journeys. Support, determination, knowledge, bed-sharing and Covid-19 pandemic social restrictions helped to sustain breastfeeding beyond 1 year. Benefits of breastfeeding beyond 1 year such as nutrition, strengthening of emotional bonds, development of a parenting tool, and protection of child and maternal health were identified. Our findings support the need for discussions and further research on the normalization of breastfeeding beyond 1 year in the Republic of Ireland, targeted health promotion initiatives and education programmes for healthcare professionals on supporting the continuation of breastfeeding.

Kajian Pengetahuan Ibu Tentang Autis dan Gizi Anak Autisdi Sekolah Luar Biasa (SLB) Negeri Nunumeu-Soe

Autism is a variant of autism spectrum disorder characterized by social communication difficulties and language barriers, narrow interests and rigid and repetitive behavior. This research aims to examine mothers' knowledge about autism and nutrition for autistic children at Nunumeu-Soe State Special School. This research is a qualitative research. Data collection was carried out using in-depth interview techniques with six informants who have autistic children at Nunumeu-Soe State Special School. The results of the research found that not all informants knew the symptoms of children with autism, so it was discovered that when children were 3-5 years old, the symptoms of autism that were often noticed were difficulty speaking and hyperactivity. Not all informants gave breast milk until the child was two years old due to work factors and replaced it with formula milk. All informants did not know the type of autistic behavior that influences children's consumption patterns, but the informants already knew the levels of autism. Mother's knowledge about nutrition for autistic children regarding types of food that adapt to the child's wishes containing gluten and casein. Food taboos in children are well known, but often escape the mother's attention due to permissive parenting, which causes serious symptoms in children. Barriers to health services and a lack of health workers in TTS district resulted in a lack of informant knowledge. Schools need to consult with local health services to educate parents about the nutrition of autistic children regarding the type of behavior and dietary restrictions of autistic children.