Commercial Formula Research Articles

Preparing Enteral Formulas for Adult Patients with Phenylketonuria: A Minor Necessity but Major Challenge—A Case Report

Phenylketonuria (PKU) is the most frequent of the congenital errors of amino acid (AA) metabolism worldwide. It leads to the accumulation of the essential AA phenylalanine (Phe) and it is associated with severe neurological defects. The early diagnosis and treatment of this rare disease, achieved through newborn screening and low-Phe diet, has profoundly changed its clinical spectrum, resulting in normal cognitive development. We face the first generation of PKU patients perinatally diagnosed and treated who have reached adulthood, whose special needs must be addressed, including feeding through enteral nutrition (EN). However, recommendations regarding EN in PKU constitute a gap in the literature. Although protein substitutes for patients with PKU are offered in multiple forms (Phe-free L-amino acid or casein glycomacropeptide supplements), none of these commercial formulas ensures the whole provision of daily total energy and protein requirements, including a safe amount of Phe. Consequently, the combination of different products becomes necessary when artificial nutrition via tube feeding is required. Importantly, the composition of these specific formulas may result in physicochemical interactions when they are mixed with standard EN products, leading to enteral feeding tubes clogging, and also gastrointestinal concerns due to hyperosmolality. Herein, we present the first reported case of EN use in an adult patient with PKU, where the separate administration of protein substitutes and the other EN products avoided physicochemical interactions.

Cost and proportion of income spent on home-made blenderized admixtures and commercial formula for enteral nutrition

Cost and proportion of income spent on home-made blenderized admixtures and commercial formula for enteral nutrition

Productivity of the Tsigai sheep breed under different feeding regimens

In the present study, the influence of levels of feeding on the formation and development of economic and commercial traits of Tsigai breed was studied in the conditions of the southern steppe of Ukraine. The research was conducted on purebred sheep from birth to 14 months of age. For this purpose, 2 groups of 3.5-4 years old ewes of the first class were selected with 40 heads in each class. It was established that poor feeding of ewes (experimental diet and below standard nutritional levels) and their offspring at the early stage of ontogenesis had a negative effect on the formation and growth of productive qualities of lambs, means of live weight and wool productivity indicators. Qualitative and quantitative indicators of wool was better in ewes obtained from mothers of the control group (received a balanced diet in accordance with the standard of feeding). Advantage in length of wool in 12 months age was 29.3%, shearing of unwashed wool (26.7%), washed (26.5%), strength of wool at 4 months of age (10.5%), and in the 14th month aged was 5%. The improvement in housing and nutrition conditions in the control group proved that the counts were better and this had a very positive effect on the productivity of the sheep. In conclusion, full-fledged feeding of ewes of the Tsigai breed ensured good development of offspring at all stages of ontogenesis and contributed to the birth of healthy, viable lambs that are capable of high productivity. Any declines in nutrients of Tsigai sheep breed (from standards of commercial formula) can cause considerable deficiency in productivity of animal.

Healthcare professionals and commercial milk formula recommendations in the urban Mexican context.

Breastfeeding (BF) is considered an essential component of optimal care for child health and development. In the past two decades, global data have shown improvements in some, but not all, BF indicators. Despite these positive changes sales and per capita intake of commercial milk formula (CMF) have increased globally. The CMF industry invests millions of dollars in marketing, which targets families and healthcare professionals (HCP). In Mexico, more than half of the mothers (53%) who feed their infants with CMF chose their Brand on the recommendation of HCP. Understanding the reasons behind the current recommendations for the use of CMF by HCP is important for the design of BF interventions. The primary objective of this study was to explore Mexican HCP' beliefs, attitudes, perceptions, and practices about early infant feeding practices, and reasons for recommending CMF. The secondary objective was to explore pregnant women and mother's perceptions of the infant feeding recommendations they received from HCP, and of the factors that influenced their infant feeding decisions. The study was based on a secondary qualitative data analysis of a WHO/UNICEF multi-country study. We analyzed focus group discussions (FGDs) and in-depth interviews (IDIs) from Mexico. Data were collected through convenience sampling in Mexico City and Guadalajara. HCP (n = 34) analysis was based on IDIs, and pregnant women or mothers of children 0-18 months (n = 74) on FGDs and IDIs. Through a thematic analysis, we identified the socioecology of BF and triangulated HCP and women's accounts. HCP, pregnant women, and mothers recognized that several factors might have influenced their infant feeding decisions including healthcare facilities' policies and maternal work conditions. Although HCP believed that BF is the best way to feed newborns and young children, they routinely recommended CMF. On the other hand, pregnant women and mothers had a strong belief that BF is the best way to feed their babies. However, when women sought support from HCP, the latter often recommended switching to CMF. This study highlights the discordance between HCP perceptions and mothers' experiences of HCP recommendations about infant feeding. Our findings support a national call for policy actions.

A perspective on how glyphosate and 2,4-D in wetlands may impact climate change

An increase in herbicide use is occurring due to a growing population and herbicide-resistant crops in agriculture, which has resulted in more herbicide tolerant target species. Glyphosate and 2,4-Dichlorophenoxyacetic acid (2,4-D) are two of the most commonly used herbicides worldwide and are more recently being used in combination in pre-mixed commercial formulas. Subsequently, herbicide contamination of wetlands will increase exposure of microorganisms to multiple chemical stressors. Methane is a potent greenhouse gas naturally emitted from wetlands, but herbicides may disrupt biogeochemical processes leading to an unbalanced methane cycle. We review the impacts of these herbicides on aquatic microbial communities from glyphosate-derived nutrient enrichment and 2,4-D inhibition of methane oxidation, and examine how these altered metabolic processes may lead to increased methane production in wetlands. The response of wetland ecosystems to herbicide contamination will vary across regions, in part due to the complexity of microbial communities, however, this perspective gives a glimpse into the potential global implications of continuing herbicide use on wetlands and demonstrates the importance for research on ecosystem-level co-stressors.

PSXI-20 Effects of Termite Meal Supplementation on Egg-Laying Hens and Their Egg Quality

Abstract Recently, the interest in utilizing insect meal as an alternative protein and energy source in chicken production has emerged in developed and developing countries. The damp wood termite Hodotermopsis sjostedti is most unlikely to be a pest among termite species, which enhances its expectation as a potential feed source. Furthermore, termites are generally known for their longevity. This study investigated the effects of termite (H. sjostedti) meal supplementation on BW, feed intake, laying performance, egg quality, and blood plasma profiles for aged Japanese Momiji layer hens as a small-scale preliminary trial. Ten laying aged hens [initial age 99.4 wk old and body weight (BW) 1.98 kg] resided in individual pens were randomly divided into two groups for similar mean BW, egg laying rate, and egg weight and offered either a high-performance commercial formula [COM; 18.0% crude protein (CP) and > 2,850 kcal/kg metabolic energy] or [TM; 2.5% inclusion of freeze-dried ground termite meal (19.1% CP)]. After 12 d of an adaptation period with the treatment diets, eggs were collected daily for 8 d. Each sampled egg was measured for a whole egg, albumen, and yolk weight, albumen and yolk height, yolk diameter, and yolk color referring to the DSM Yolk Color Fan, and eggshell thickness and strength. The egg-laying rate and Haugh unit were calculated. At the end of the study, BW and feed intake were measured individually, and blood samples were collected from the brachial wing vein. All the egg quality values were averaged by hen so that data with one value per hen were analyzed by GLM of SAS. Final BW (P = 0.069) and egg yolk height (P = 0.082) tended to be greater for TM hens than COM hens, whereas feed intake, egg weight, feed efficiency, egg laying rate, and also egg quality traits were similar between the treatments. The whole egg and albumen weights of hens were greater than regular eggs because of their old age. All the hens had increased blood Ca, triglyceride, and phospholipid concentrations, probably because of the base diet formulation and their old age. On the other hand, blood urea nitrogen for TM hens tended to be less (P = 0.055) than COM hens, despite the greater CP concentration in the TM diet. Blood total protein was numerically greater for TM than COM, which implies greater protein metabolism in the diet for TM hens and may support and explain their greater final BW. In conclusion, termite meal supplementation in the high-performance commercial chicken diet enhanced the protein concentration and potential metabolization that suggested preferable tendencies in aged laying hens, which requires further investigation.

How the marketing practices of commercial milk formula companies impact infant breastfeeding practices in China

BackgroundThe marketing practices used by commercial milk formula (CMF) companies undermine breast feeding. However, it remains unclear how specific types of marketing practices result in suboptimal breast feeding.ObjectivesWe aimed to...

Commercial probiotic formulas Bactocell and Levucell promote spring brood production in Apis mellifera L. (Hymenoptera: Apidae) colonies.

Honey bees are essential pollinators for several economically important crops. In temperate countries, honey bee colonies face multiple threats during the overwintering period, such as food availability, diseases, and confinement. Beekeepers commonly use chemicals to improve colony health during winter, but these products can have a negative impact on bee health and pathogens can develop resistance to them. Thus, there is a need for further development of alternative treatments. The aim of this study was to evaluate the impact of one endogenic bacterium (Bombella apis) and 2 commercial probiotic formulas (Bactocell and Levucell) on colony survival, spring development, and Vairimorpha (formerly Nosema) spp. spore count. Probiotic treatments were given in 1: 1 sugar syrup in October 2017 and April 2018, once a week for 2 wk. One experimental group was given Fumagilin-B, the only product approved in Canada to prevent nosemosis, once in October. The administration of 2 commercial probiotics, Bactocell (Pediococcus acidilactici) and Levucell (Saccharomyces cerevisiae boulardii), led to a significant increase in the number of sealed brood cells in spring. None of the probiotic treatments impacted the honey bee gut load of Vairimorpha spp. spores. The results suggest that beneficial microorganisms can improve spring development and performance of honey bee colonies.

The impact of the international code of marketing of breast-milk substitutes in Ghana and Tanzania

Abstract Background Measures that promote and protect breastfeeding have a major impact on child survival rates, as it was estimated that increasing breastfeeding rates can reduce child mortality by 13% in Africa. The International Code of Marketing of Breast-Milk Substitutes is an important measure to protect and promote breastfeeding and the safe use of commercial milk formulas. Ghana and Tanzania adopted measures that are substantially aligned with the Code into national legislation in 2000 and 1994, respectively. Methods In this study, we estimate the effects of the Code implementation through national laws on child mortality in Ghana and Tanzania by using the synthetic control group method and performing placebo tests to assess statistical inference. The main outcome is the effect of the national laws on overall child mortality and secondary outcomes are the effect of the laws on child mortality by lower respiratory infections and diarrhea in both countries. Results Two-sided inference tests showed a statistically significant treatment effect for deaths by lower respiratory infections in Ghana (p = 0.0476; LTE = - 0.8423) and one-sided inference tests showed statistically significant treatment effects for deaths by lower respiratory infections in Ghana (p = 0.0476; LTE = -0.8423) and Tanzania (p = 0.0476; LTE = - 5.1627), and for diarrhea in Tanzania (p = 0.0476; LTE = - 8.1694). To corroborate our results, we also performed the analysis for two major causes of child mortality that are not affected by the intervention, namely congenital diseases and birth asphyxia and trauma birth, for which we did not find significant treatment effects. Conclusions The results demonstrate that the Code had a potentially beneficial impact on child mortality in Ghana and Tanzania and corroborate previous research that the Code is a necessary but insufficient step to alone improve child health outcomes. Key messages • The results show that the implementation of the Code had a potentially beneficial impact on child mortality in Ghana and Tanzania. • Policymakers should consider implementing or strengthening the Code within countries in order to improve child and health outcomes.

Law matters - assessment of country-level code implementation and sales of breastmilk substitutes in South Asia.

This study examines the status of implementation of the International Code of Marketing of Breast-milk Substitutes of eight countries in the South Asia region (Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka), and describes the sales value and volume of commercial milk formula (CMF) marketed as breastmilk substitutes (BMS) and baby food in four countries (Bangladesh, India, Pakistan, and Sri Lanka). A mix of descriptive methods is used to assess national status of Code implementation, including a desk review of the 2022 WHO/UNICEF/IBFAN Code Status Report, systematic content analysis of national Code measures, and insights generated from the participation of key government and UNICEF/WHO actors in a regional workshop that aimed to identify each country's barriers, gaps, and the status of Code implementation. Data on the sales value and volume of CMF and baby food between 2007 to 2021 and with the prediction to 2026 in Bangladesh, India, Pakistan, and Sri Lanka were obtained from Global Data. There are major gaps in Code implementation in countries even with legal measures considered substantially aligned with the Code, such as the inadequate age range of CMF covered in the scope, insufficient safeguards against conflicts of interest in the health system, lack of warning of risks of intrinsic contamination of powdered milk formula, and an absence of effective monitoring and enforcement mechanisms. Data on CMF sales shows health facilities and pharmacies sustain the highest sales. Lower sales volume of infant formula (including special formula), compared to other CMF such as follow-up formula and growing-up milk, has been observed in three of the four countries (Bangladesh, India, and Sri Lanka). Overall, GUM, followed by baby cereals, accounted for a large portion of CMF and baby foods sales in the same three countries. (1) Closing the gaps between national measures and the Code, (2) Ensuring effective monitoring and enforcement mechanisms, (3) Strengthening conflicts of interest safeguards in the health system, (4) Tackling digital marketing, and (5) Galvanizing political support and support from in-country public health and women's rights jurist networks.

Microbiological contamination present in enteral tube feeding prepared in hospitals and/or at home: a systematic review.

The safety of enteral formulas is important to restore and maintain the health of patients. A systematic review of the literature was conducted to assess the microbiological contamination present in enteral tube feeding prepared in hospitals and/or at home. A systematic search was conducted of the Medline, Scopus, BVS, CAPES/MEC, Embase, Science Direct, and SciELO databases and gray literature. Eligible studies that analyzed the contamination of enteral formulas manipulated in hospitals and/or at home were selected; a quality assessment tool was used. Twenty-three studies evaluated 1099 enteral formulations. Of these, 44.67% of enteral formulas (n = 491) exceeded the acceptable bacterial count. Samples of homemade enteral formulation preparations (86.03%; n = 191) had the highest bacterial counts, followed by mixed preparations (79.72%; n = 59), and commercial formulas (30.01%; n = 241). The number of samples of enteral formulations that exceeded the bacterial count at home was 70.79% (n = 160 at the hospital was 37.91% (n = 331). Total coliforms (82.68%; n = 406) and mesophilic aerobes (79.22%; n = 389) were the most common microorganisms. Samples with bacterial pathogens were also identified, with Bacillus cereus (4.07%; n = 20) and Listeria monocytogenes (3.66%; n = 18) being the most prevalent. A high number of samples of enteral formulations exceeded the bacterial count, but the risk to patient's health when consuming enteral tube feeding prepared in hospitals or at home may be low. This is because the bacteria present in the samples are not considered potential causes of disease but rather indicators of hygiene conditions. PROSPERO registration no. CRD42022367573.

Breastfeeding and infant care as 'sexed' care work: reconsideration of the three Rs to enable women's rights, economic empowerment, nutrition and health.

Women's lifelong health and nutrition status is intricately related to their reproductive history, including the number and spacing of their pregnancies and births, and for how long and how intensively they breastfeed their children. In turn, women's reproductive biology is closely linked to their social roles and situation, including regarding economic disadvantage and disproportionate unpaid work. Recognizing, as well as reducing and redistributing women's care and domestic work (known as the 'Three Rs'), is an established framework for addressing women's inequitable unpaid care work. However, the care work of breastfeeding presents a dilemma, and is even a divisive issue, for advocates of women's empowerment, because reducing breastfeeding and replacing it with commercial milk formula risks harming women's and children's health. It is therefore necessary for the interaction between women's reproductive biology and infant care role to be recognized in order to support women's human rights and enable governments to implement economic, employment and other policies to empower women. In this paper, we argue that breastfeeding-like childbirth-is reproductive work that should not be reduced and cannot sensibly be directly redistributed to fathers or others. Rather, we contend that the Three Rs agenda should be reconceptualized to isolate breastfeeding as 'sexed' care work that should be supported rather than reduced with action taken to avoid undermining breastfeeding. This means that initiatives toward gender equality should be assessed against their impact on women's ability to breastfeed. With this reconceptualization, adjustments are also needed to key global economic institutions and national statistical systems to appropriately recognize the value of this work. Additional structural supports such as maternity protection and childcare are needed to ensure that childbearing and breastfeeding do not disadvantage women amidst efforts to reduce gender pay gaps and gender economic inequality. Distinct policy interventions are also required to facilitate fathers' engagement in enabling and supporting breastfeeding through sharing the other unpaid care work associated with parents' time-consuming care responsibilities, for both infants and young children and related household work.

Blenderized tube feedings: Practice recommendations from the American Society for Parenteral and Enteral Nutrition.

Prior to the 1970s, blending food and liquids and putting them through an enteral access device (EAD) was the most common form of enteral nutrition (EN). However, in the 1970s, blenderized tube feedings (BTFs) became less popular due to the emergence of modern commercial enteral formulas (CEFs). Recently, a cultural shift toward consuming a natural diet, consisting of whole foods, has led to a resurgence in the use of BTF. The increasing use of BTF in a variety of patient care settings identifies a need for practice recommendations that provide guidance for nutrition professionals and patients. Members of the American Society for Parental and Enteral Nutrition (ASPEN) Enteral Nutrition Committee identified salient clinical questions concerning BTF, conducted a comprehensive literature search, and subsequently developed practice recommendations pertaining to the use of BTF. This paper was approved by the ASPEN 2022-2023 Board of Directors.

FOOTBALL SUPER LEAGUE AND THE VALUES OF EUROPEAN SPORT. CRITICAL ANALYSIS OF THE OPINION OF THE ADVOCATE GENERAL IN CASE C-333/21

The article presents author’s own opinion on case C-333/21 which concerns the controversial project of organizing a football Super League (ESL). The aim of this initiative is to develop a commercial organizational formula for football competition, which at the same time would be independent of the structures of FIFA and UEFA. For the above reasons, the resolution of the dispute before the Court of Justice of the European Union has a significant impact on the answer to the question about the future of the organizational structure of European football. In this case, the EU competition law and the determination of a catalog of values are of fundamental importance that could possibly justify compliance of the restrictions applied by FIFA and UEFA in relation to ESL organizers with Articles 101 and 102 TFUE.

Corrigendum: Challenging the Maligning of Homemade Human Milk Substitutes During a Shortage of Commercial Formula

Correction to: CAND Journal. 2023;30(2):14–19.https://doi.org/10.54434/candj.130

Addendum: Challenging the Maligning of Homemade Human Milk Substitutes During a Shortage of Commercial Formula

Addendum to: CAND Journal. 2023;30(2):14–19.https://doi.org/10.54434/candj.130

Fatty acid concentration and distribution in human milk: Comparison with infant formulas and animal milk

AbstractThe lipid profile including total fatty acid (FA), sn‐2 positional distribution on triacylglycerol, and phospholipid (PL) FA in human milk, infant formulas, and animal milk (cow, goat, camel, donkey, and yak milk) were analyzed. Animal milk contained higher saturated fatty acids (45.08%–66.29%) than human milk (37.44%) and infant formula (33.46%). In the perspective of FA, human milk and the commercial formulas showed a better similarity. Human milk contained significantly (p < 0.05) higher 16:0 at the sn‐2 position (50.88%) than infant formulas (23.09%) and animal milk (28.95%–46.72%). As to PL‐FA, human milk contained significantly (p < 0.05) higher 16:0 and 18:0 but lower 18:1 n‐9 than other milk. The relative contents of arachidonic acid (AA), docosahexaenoic acid (DHA), and nervonic acid (NA) in human milk were higher in PL‐FA than that in total FA. Noteworthy, the contents of AA, DHA, and NA in both total FA and PL‐FA were higher in human milk than other milk. These results indicated that the fortification of 16:0 at the sn‐2 position, and AA, DHA, and NA in both total FA and PL‐FA could improve the quality of infant formulas.

Osmolality of fortified donor human milk: An experimental study.

We quantify the osmolality of human milk fortified with human milk fortifiers (HMFs), powder infant formulas and protein additives. Commercial liquid HMFs and powder infant formulas were added to pasteurized pooled donor human milk in triplicate and stirred. The osmolality of unfortified and fortified human milk at 22, 24, 26, 27, 28, and 30 kcal/oz (0.73, 0.8, 0.87, 0.9, 0.93, and 1 kcal/ml, respectively) was determined using freezing-point depression. The osmolality of fortified human milk associated with energy density in a linear relationship regardless of the fortification strategies. Multiple liquid HMFs and every powder infant formula exceeded the osmolality threshold of 450 mOsm/kg H2 O within the energy densities tested. The osmolality of fortified human milk is highly variable and should be considered when selecting a fortifying agent for human milk.

3-Monochloropropane-1,2-diol reduced bioaccessibility of sn-2 palmitate via binding with pancreatic lipase in infant formula during gastrointestinal digestion

Infant formula contains 3-monochloropropane-1,2-diol esters (3-MCPDE), which are formed during the deodorization step of vegetable oil refining. The European Food Safety Authority stated that 3-MCPDE can be hydrolyzed in the gastrointestinal tract to free-form 3-monochloropropane-1,2-diol (3-MCPD), which has potential toxicity and can be rapidly absorbed. Evaluating the effect of 3-MCPD on nutrition absorption is a prerequisite for establishing effective management strategies. A total of 66 crucial lipid molecules associated with 3-MCPD were identified based on debiased sparse partial correlation analysis. 3-MCPD affected triglyceride hydrolyzation and increased the concentration of undigested sn-2 palmitate (9.57 to 17.06 mg kg-1). 3-Monochloropropane-1,2-diol reduced the bioaccessibility of fatty acids, and more short- (31.42 to 58.02 mg kg-1) and medium-chain fatty acids (17.03 to 26.43 mg kg-1) remained unabsorbed. Lipidomic profiles of infant formula models spiked with different 3-MCPDE levels were investigated, and the results were consistent with the experiments with the commercial formula indicating lipid alteration was mainly affected by the digestive 3-MCPD. The formation of 3-MCPD ester-pancreatic lipase with the binding energy of -4.9 kcal mol-1 was more stable than triglyceride-pancreatic lipase (-4.0 kcal mol-1), affecting triglyceride hydrolyzation. 3-Monochloropropane-1,2-diol was bound to Glu13 and Asp331 residues of the pancreatic lipase via hydrogen bonds, which resulted in a conformational change of pancreatic lipase and spatial shielding effect. The existence of the spatial-shielding effect reduced the accessibility of pancreatic lipase and further affected triglyceride hydrolyzation. These findings indicated that 3-MCPD obstructed nutrient acquisition and laid the foundation for the subsequent nutrition enhancement design.

How Benthic Sediment Microbial Communities Respond to Glyphosate and Its Metabolite: a Microcosm Experiment.

Glyphosate is the most commonly used agricultural herbicide in the world. In aquatic ecosystems, glyphosate often adsorbs to benthic substrates or is metabolized and degraded by microorganisms. The effects of glyphosate on microbial communities vary widely as microorganisms respond differently to exposure. To help understand the impacts of glyphosate on the sediment microbiome, we conducted a microcosm experiment examining the responses of benthic sediment microbial communities to herbicide treatments. Sediments from a prairie pothole wetland were collected, and 16S rRNA gene sequencing was used to analyze community composition 2-h and 14-days after a single treatment of low (0.07 ppm), medium (0.7 ppm), or high (7 ppm) glyphosate, aminomethylphosphonic acid (glyphosate metabolite), or a glyphosate-based commercial formula. We found no significant differences in microbial community composition across treatments, concentration levels, or day of sampling. These findings suggest that microbial species in the Prairie Pothole Region of North America may be tolerant to glyphosate exposure.