Formula-fed Groups Research Articles

No effect of adding dairy lipids or long chain polyunsaturated fatty acids on formula tolerance and growth in full term infants: a randomized controlled trial

BackgroundWhen breastfeeding is not possible, infants are fed formulas in which lipids are usually of plant origin. However, the use of dairy fat in combination with plant oils enables a lipid profile in formula closer to breast milk in terms of fatty acid composition, triglyceride structure and cholesterol content. The objectives of this study were to investigate the impact on growth and gastrointestinal tolerance of a formula containing a mix of dairy lipids and plant oils in healthy infants.MethodsThis study was a monocentric, double-blind, controlled, randomized trial. Healthy term infants aged less than 3 weeks whose mothers did not breastfeed were randomly allocated to formula containing either: a mix of plant oils and dairy fat (D), only plant oils (P) or plant oils supplemented with long-chain polyunsaturated fatty acids (PDHA). Breastfed infants were included in a reference group (BF). Anthropometric parameters and body composition were measured after 2 and 4 months. Gastrointestinal tolerance was evaluated during 2 day-periods after 1 and 3 months thanks to descriptive parameters reported by parents. Nonrandomized BF infants were not included in the statistical analysis.ResultsEighty eight formula-fed and 29 BF infants were enrolled. Gains of weight, recumbent length, cranial circumference and fat mass were similar between the 3 formula-fed groups at 2 and 4 months and close to those of BF. Z-scores for weight, recumbent length and cranial circumference in all groups were within normal ranges for growth standards. No significant differences were noted among the 3 formula groups in gastrointestinal parameters (stool frequency/consistency/color), occurrence of gastrointestinal symptoms (abdominal pain, flatulence, regurgitation) or infant’s behavior.ConclusionsA formula containing a mix of dairy lipids and plant oils enables a normal growth in healthy newborns. This formula is well tolerated and does not lead to abnormal gastrointestinal symptoms. Consequently, reintroduction of dairy lipids could represent an interesting strategy to improve lipid quality in infant formulas.Trial registrationClinicalTrials.gov Identifier NCT01611649, retrospectively registered on May 25, 2012.

Lutein Is Differentially Deposited across Brain Regions following Formula or Breast Feeding of Infant Rhesus Macaques

BackgroundLutein, a yellow xanthophyll, selectively accumulates in primate retina and brain. Lutein may play a critical role in neural and retinal development, but few studies have investigated the impact of dietary source on its bioaccumulation in infants. ObjectiveWe explored the bioaccumulation of lutein in infant rhesus macaques following breastfeeding or formula-feeding. MethodsFrom birth to 6 mo of age, male and female rhesus macaques (Macaca mulatta) were either breastfed (BF) (n = 8), fed a formula supplemented with lutein, zeaxanthin, β-carotene, and lycopene (237, 19.0, 74.2, and 338 nmol/kg, supplemented formula-fed; SF) (n = 8), or fed a formula with low amounts of these carotenoids (38.6, 2.3, 21.5, and 0 nmol/kg, unsupplemented formula-fed; UF) (n = 7). The concentrations of carotenoids in serum and tissues were analyzed by HPLC. ResultsAt 6 mo of age, the BF group exhibited significantly higher lutein concentrations in serum, all brain regions, macular and peripheral retina, adipose tissue, liver, and other tissues compared to both formula-fed groups (P < 0.001). Lutein concentrations were higher in the SF group than in the UF group in serum and all tissues, with the exception of macular retina. Lutein was differentially distributed across brain areas, with the highest concentrations in the occipital cortex, regardless of the diet. Zeaxanthin was present in all brain regions but only in the BF infants; it was present in both retinal regions in all groups but was significantly enhanced in BF infants compared to either formula group (P < 0.001). β-Carotene accumulated across brain regions in all groups, but was not detected in retina. Although lycopene was found in many tissues of the SF group, it was not detected in the brain or retina. ConclusionsAlthough carotenoid supplementation of infant formula significantly increased serum and tissue lutein concentrations compared to unsupplemented formula, concentrations were still well below those in BF infants. Regardless of diet, occipital cortex showed selectively higher lutein deposition than other brain regions, suggesting lutein's role in visual processing in early life.

Low dietary protein and high carbohydrate infant formula affects the microbial ecology of the large intestine in neonatal rats.

The aim of this study was to investigate the effects of a low dietary protein and high carbohydrate infant formula on the large intestine of neonatal rats. A total of 24 neonatal Sprague-Dawley rats (14-days-old) were randomly assigned to the low protein, high carbohydrate infant formula-fed group (I group) and a human breast milk-fed group (H group). After 7 days, we selected 6 rats at random from each group to study. No significantly different microbial colonization patterns were observed in the 2 groups at the phylum level. At the family level, Enterobacteriaceae and Bacteroidaceae were the dominant bacteria in I and H rats. While Bacteroides was the most abundant bacteria at the genus level, no significant difference was observed between the 2 groups. Methanoic acid, acetate, and butyrate increased in concentration in the I group compared with the H group. Protease activities, ammonia, and indole in the large intestine were lower in I rats than H rats. A significant increase in the expression of GADPH and decrease in the expression of aquaporin 8, aminopeptidase A, cathepsin F precursor, and ubiquitin carboxyl-terminal hydrolase FAF-Y were observed in I rats compared with H rats. These results suggest that a low protein diet could modulate the microbial ecology in the large intestine of neonatal rats.

Transcriptome analysis reveals persistent effects of neonatal diet on small intestine gene expression profile in a porcine model

Breastfeeding is associated with several benefits affecting gut development and immune function. Compared to breast feeding, infant formula feeding is linked to a greater risk for gut dysfunction, ear and respiratory tract infections, and allergies. The beneficial effects appear to last at least through puberty, but the mechanism(s) underlying these long lasting effects have not been investigated. We hypothesized that relative to formula feeding, neonatal breast milk‐feeding favors the development of the gastrointestinal tract and immune system even after post‐weaning from the neonatal diet. This hypothesis was tested using a piglet model, where piglets (n=12 males/group) were fed either human breast‐milk (HBM), dairy‐based formula (FM) or sow milk (SM) from postnatal day 2 to 21, followed by a common ad libitum diet weaning solid diet until day 51. A significant reduction was found in small intestine length in HBM‐fed relative to SM‐fed groups (910±13 vs 984±19, 930±24 cm) and in small intestine weigh (362±9.7 vs 420±17 g, p&lt;0.05) of HBM‐fed relative to SM‐ and FM‐fed. Transcriptome data were analyzed with reference to Dawson laboratory's in‐house gene reference database. Gene expression data revealed a differential expression of 99 genes in HBM‐fed in comparison to SM‐fed piglets p&lt;0.05). Furthermore, FM‐fed piglets showed a differential expression of 583 genes (p&lt;0.05) in comparison to those SM‐fed. In addition, the HBM group demonstrated a 2 to 58 fold up‐regulation of 101 genes and 2 to 8 fold down regulation of 39 genes relative to FM‐fed piglets. Panther analyses of the gene list suggested the most impacted biological system was cellular process (37 genes) followed by metabolism (31 genes), development (19 genes), response to stimuli such as stress, external, internal, biotic, and toxic (16 genes), and immune system (13 genes i.e. 2‐to‐19 fold increase in ABCC12, BRAF, CALCRL, CD46, CXCL8, CXCL11, C8a, DMBT1 and a 2 fold decrease in CD79B, and ASGR1, p&lt;0.05) in HBM‐fed relative to FM‐fed piglets. In HBM‐fed piglets the major immune system pathways being regulated in the small intestine were those relayed to cytokine receptor signaling, gonadotropin release hormone receptor, chemokine/cytokine, interleukin, PDGF, TGF‐β, Wnt signaling, B‐Cell activation, cadherin, and integrin signaling. In summary, transcriptome analyses indicate that in the small intestine of piglets HBM‐feeding altered immune and other pathways, and gene targets compared to the formula‐fed group, even 30 days after being weaned onto a common diet. Studies are underway to confirm the expression data by real‐time PCR. The role of the microbiota is also being evaluated to understand the association between microbiota and host biological processes and immune system development. These findings will inform the understanding of mechanism(s) underlying benefits of human breast milk for intestinal growth, function, and development.Support or Funding InformationThis work was funded by USDA‐ARS Project 6026‐5100‐010‐05S and 1235‐51000‐055‐00D.

A pilot study of the effect of human breast milk on urinary metabolome analysis in infants.

This study aimed to examine the nutritional effect of breast feeding on healthy term infants by using urinary metabolome analysis. Urine samples were collected from 19 and 14 infants at 1 and 6 months, respectively. Infants were separated into two groups: the breast-fed group receiving <540 mL/week of their intake from formula (n=13 at 1 month; n=9 at 6 months); and the formula-fed group receiving no breast milk (BM) (n=6 at 1 month; n=5 at 6 months). Urinary metabolome analysis was performed using capillary electrophoresis-time-of-flight mass spectrometry (CE-TOF/MS). A total of 29 metabolites were detected by CE-TOF/MS metabolome analysis in all samples. Urinary excretion of choline metabolites (choline base solution, N,N-dimethylglycine, sarcosine, and betaine) at 1 month were significantly (p<0.05) higher in breast-fed infants than in formula-fed infants. However, choline metabolites were not significantly different between the groups at 6 months. Urinary excretion of lactic acid in breast-fed infants at 1 and 6 months was significantly lower than that in formula-fed infants. Urinary l(-)-threonine and l-carnosine excretion at 1 month was significantly lower in breast-fed infants than in formula-fed infants, but it was not significantly different between the groups at 6 months. The type of feeding in early infancy affects choline metabolism, as well as lactate, threonine, and carnosine levels, in healthy term infants. Urinary metabolome analysis by the CE-TOF/MS method is useful for assessing nutritional metabolism in infants.

Bifidobacterium adolescentis protects against necrotizing enterocolitis and upregulates TOLLIP and SIGIRR in premature neonatal rats

BackgroundNecrotizing enterocolitis (NEC) is a serious gastrointestinal disorder that is often seen in premature infants. Probiotics decrease the risk of NEC; however, the mechanism by which probiotics work is not clear. The goal of this study was to evaluate the preventive effect of Bifidobacterium adolescentis in an NEC rat model.MethodsSprague-Dawley neonatal rats were obtained by caesarean section after 20-21 d gestation and randomly divided into the following 3 groups: dam fed (DF), formula fed (FF), and formula + B. adolescentis (FB). Those in the FF and FB groups developed NEC after exposure to asphyxia and cold stress. All rats were sacrificed 72 h after birth and intestinal injury and mRNA expression of TLR4, TOLLIP and SIGIRR were assessed.ResultsB. adolescentis significantly increased the 72-h survival rate from 56.3% in the FF group to 86.7% in the FB group. B. adolescentis significantly reduced the histological score from a median of 3.0 in the FF group to a median of 1.0 in the FB group,and significantly decreased the rate of NEC-like intestinal injury from 77.8% in the FF group to 23.1% in the FB group. The mRNA expression of TLR4 increased 3.6 fold in the FF group but decreased by 2 fold from B. adolescentis treatment. mRNA expression of TOLLIP and SIGIRR decreased 4.3 and 3.7 fold, respectively, in the FF group. B. adolescentis significantly increased mRNA expression of TOLLIP and SIGIRR by 3.7 fold and 2.6 fold, respectively.ConclusionsThis study demonstrated B. adolescentis prevents NEC in preterm neonatal rats and that the mechanism for this action might be associated with the alteration of TLR4, TOLLIP, and SIGIRR expression.

SN2-Palmitate Improves Crying and Sleep in Infants Fed Formula with Prebiotics: A Double-Blind Randomized Clinical Trial

Background and Aim: Palmitic acid (PA, C16:0), one of the major saturated fatty acids in human milk fat being 17-25% of the fatty acids, is esterified mainly at the SN2-position (SN2-palmitate). Contrary in vegetable oils, which are commonly used as fat source in infant formulas, PA is esterified mainly at the outer positions, i.e, SN1 and SN3 positions, resulting in reduced fat absorption and harder stools. SN2-palmitate and prebiotics have been shown to improve digestion and reduce stool hardness. Our aim was to study the potential effects of SN2-palmitate in addition to prebiotics in formula-fed Chinese infants. Methods: 171 healthy term infants were included (within 14 days from birth) in the study. Formula-fed infants were randomly assigned to receive either SN2-palmitate containing formula (INFAT®, Advanced Lipids), (n=57) or a Control formula (n=57). The two study formulas (Biostime, China) differed only in the ratio of PA at the SN2-position (43% vs. 13%). A similar group of breastfed infants (n=57) was included as a reference. Results: The pattern of crying and sleep differed between the formula-fed groups. Fewer infants in the SN2 group cried at 12 weeks (23.2% vs. 45.5%, p<0.05); they had fewer crying episodes (2.0 vs. 3.6, at 6 weeks, p<0.05 and 1.0 vs. 2.2 at 12 weeks, p<0.02) and the duration of crying was lower (25.1 vs. 41.3 min at 6 weeks, p<0.05 and 11.2 vs. 21.2 min at 12 weeks, p<0.01) similar to the crying pattern of breastfed infants. Moreover, the infants in the SN2 group had longer daily sleep duration. Conclusions: SN2-palmitate formula improves crying and sleeps patterns in addition to prebiotics in the first weeks of life. Thereby, SN2-palmitate improves the well-being of formula-fed infants and consequently the quality of life of their parents, further emphasizing the importance of SN2-palmitate for infant nutrition.

Nutrition, growth and development of very-low-birth-weight infants after discharge

Objective To explore the effect of breast feeding plus human milk fortifier and formula on growth and development of very-low-birth-weight (VLBW) infants after discharge through monitoring post-discharge nutritional status, growth, and development of VLBW infants. Methods A total of 143 preterm VLBW infants were divided into two groups according to feeding mode after discharge: breastfeeding+ human milk fortifier group, and formula feeding group. Body length, weight, and head circumference of each group were recorded and analyzed at corrected age of 40 weeks and 52 weeks. Results The extrauterine growth retardation rates of weight, length, and head circumference of the 143 infants were 35.25%, 32.43%, and 14.41%, respectively at corrected age of 40 weeks; 9.52%, 10.81%, and 2.7%, respectively at corrected age of 52 weeks. There were no statistically significant differences between the two groups in growth and development. At the corrected age of 40, 52, and 56 weeks, 18.67%, 56.0%, and 68.75% of the cases were shifted from human milk fortifier to formula feeding or exclusive breastfeeding. Conclusions Post-discharge intensive nutritional management may accelerate grow of VLBW infants. There are little difference in growth and development between formula-feeding VLBW infants and those fed with mother's milk plus human milk fortifier. Key words: Infant; very-low-birth-weight; Human milk fortifier; Post-discharge formula; Growth restriction

Gut wall integrity in exclusively breastfed vs. formula-fed infants

Background Breast milk has bioactive substances that modulate gastrointestinal maturation and maintain mucosal integrity of the gut in infants. Markers that are both non-invasive and reliable, such as fecal alpha-1 antitrypsin (AAT), calprotectin, and secretory immunoglobulin A (sIgA) have been used to assess gut integrity in adults. Higher AAT levels may imply greater enteric protein loss due to increase intestinal permeability of immaturity gut.Objective To assess and compare gut integrity of exclusively breastfed (BF) and exclusively formula fed (FF) infants aged 4-6 months.Methods Subjects were 80 healthy infants (BF=40; FF=40), aged 4-6 months who visited the Pediatric Polyclinic at St. Carolus Hospital, and lived in Pasar Minggu or Cempaka Putih Districts, Jakarta. The fecal AAT was analyzed by an ELISA method. Mann-Whitney and unpaired T-test were used to analyze possible correlations between feeding type and gut integrity.Results The BF group had significantly higher mean fecal AAT than the FF group (P=0.02). Median sIgA levels were not significantly different between groups (P=0.104). The FF group had a higher mean fecal calprotectin level but this difference was also not significant (P=0.443). There was a significant correlation between breastfeeding and mean fecal AAT level (P=0.02), but no significant correlation with calprotectin (P=0.65) or sIgA (P=0.26).Conclusion The breastfed group shows better mucosal integrity compared to the formula fed group. Higher mean fecal AAT level in the BF group is related to the AAT content of breast milk. Therefore AAT content of BF group is actually lower than formula fed group which shows greater mucosal integrity in BF group.

Infant feeding and health-related quality of life in healthy Chinese infants: results from a prospective, observational cohort study.

BackgroundInfant feeding regimens, including breastfeeding, formula-feeding, or a combination of the two, may influence infant health-related quality of life (HRQOL). However, few studies have examined this association.MethodsThis prospective cohort study assessed HRQOL in relation to three parent-selected feeding regimens: exclusively breastfed (n = 136), exclusively study formula-fed (n = 140), and mixed-fed with study formula and breast milk (n = 151). Healthy Chinese infants were enrolled at their first normally scheduled well infant clinic visit at age 42 days (study day 1). Parents independently chose their infants’ feeding regimens prior to recruitment into the study, with infants in the formula and mixed-fed groups already consuming an infant formula enriched with α-lactalbumin and increased sn-2 palmitate and oligofructose. The Infant and Toddler Quality of Life Questionnaire, which includes six infant-focused and three parent-focused concepts, was used to assess HRQOL at day 1 and at a follow-up visit 48 days later. Scores for each concept ranged from 0 to 100. Parent quality of life (assessed using the Mental Component Summary score of the SF-12v2 Health Survey) was included in the ANCOVA model to adjust for its potential effect on parent’s perception of infant HRQOL.ResultsHRQOL concept scores were high in all three study groups at both visits (mean scores 71–95). Day 1 HRQOL scores were not significantly different between groups. At day 48, 5 of 9 HRQOL scores were not significantly different between groups. However, scores for Temperament and Moods, General Health Perceptions and Parent Impact–Time were slightly but statistically significantly lower in the formula-fed group (mean scores 75–86; all p ≤ 0.01) compared to the breastfed (78–90) and mixed-fed (77–91) groups. Day 48 Parent Impact–Emotional scores were also significantly lower by a small margin (4 points; p = 0.003) in the formula-fed group compared with the breastfed group.ConclusionsHRQOL was high in this population of healthy infants, with only a few small differences in HRQOL concept scores observed between breastfed, formula-fed and mixed-fed infants. These results indicate favorable physical, mental, and social well-being in these infants and parents. Assessment of infant HRQOL is therefore feasible and provides valuable insight into parental perceptions of their child’s health and well-being.Trial registrationClinicalTrials.gov, NCT01370967.

Formula Feeding Is Independently Associated With Acute Kidney Injury in Very Low Birth Weight Infants.

Successful strategies to prevent neonatal acute kidney injury are lacking. Nevertheless, it is well known that in breastfed babies the excretory needs of the kidney are low because the intake of most nutrients is just above the nutritional requirement. This study aimed to determine whether feeding type predicts acute kidney injury in the very low birth weight infant. One hundred and eighty-six infants were enrolled in this pre-post cohort study (114 infants were included in the only human milk-fed group and 72 in the formula-fed group). Routine biological markers of acute kidney injury were collected in both groups from birth to discharge. Compared with formula feeding, human milk feeding was associated with almost 80% lower odds of acute kidney injury (odds ratio [OR] = 0.2; 95% confidence interval [CI], 0.05-0.77). After confounding variables had been controlled for, formula feeding was independently associated with acute kidney injury in very low birth weight infants. The study showed that, at our institution, acute kidney injury in the neonatal period is frequently associated with the avoidable procedure of formula feeding. Further prospective multicenter studies are needed to determine the generality of this association.

Sialylated galacto-oligosaccharides and 2'-fucosyllactose reduce necrotising enterocolitis in neonatal rats.

Necrotising enterocolitis (NEC) is one of the most frequent and fatal intestinal disorders in preterm infants and has very limited treatment options. Breast-fed infants are at a 6-10-fold lower NEC risk than formula-fed infants, and we have previously shown that human milk oligosaccharides (HMO) improved survival and reduced pathology in a rat NEC model. The HMO disialyllacto-N-tetraose (DSLNT) was most effective, and sialylation was shown to be essential for its protective effect. Galacto-oligosaccharides (GOS), currently added to some infant formula, but not containing sialic acid, had no effect. In addition to DSLNT, our previous work also showed that the neutral HMO fraction, which contains high concentrations of 2'-fucosyllactose (2'FL), slightly improved pathology scores. Here, we assessed the in vivo efficacy of 2'FL, as well as of GOS that we enzymatically sialylated (Sia-GOS). Neonatal rats were randomised into the following study groups - dam-fed (DF), formula-fed (FF), FF containing pooled HMO (10 mg/ml), GOS (8 mg/ml), Sia-GOS (500 µm) or 2'FL (2 mg/ml) - and subjected to the established NEC protocol. The DF and HMO groups had the lowest pathology scores with mean values of 0·67 (sd 0·34) and 0·90 (sd 0·47), respectively. The FF group had significantly elevated pathology scores of 2·02 (sd 0·63). Although the addition of GOS to the formula had no protective effect and generated scores of 2·00 (sd 0·63), the addition of Sia-GOS or 2'FL significantly lowered pathology scores to 1·32 (sd 0·56) (P<0·0034) and 1·43 (sd 0·51) (P<0·0040), respectively. The results warrant further studies to investigate the underlying mechanisms and to assess safety and efficacy in human neonates.

Exclusive breastfeeding rate and factors associated with infant feeding practices in Indonesia

Background Breast milk is the ideal food for infants. According to the 2007 Indonesian National Household Health Survey, only 23% of mothers exclusively breastfeed for six months.Objectives To determine the rate of exclusive breastfeeding in Indonesia, to evaluate factors associated with infant feeding practices, and to compare the nutritional and developmental status between exclusively-breastfed and formula-fed infants.Methods A survey was conducted in hospitals located in 17 provinces in Indonesia. The rate of exclusive breastfeeding was calculated. Many variables were investigated as potential predictors for exclusive breastfeeding using a multivariable logistic regression analysis. Further analysis was performed to compare the nutritional and developmental status between exclusively breastfed and formula-fed infants at the time of survey.Results From 1,804 infant subjects, the overall rate of exclusive breastfeeding was 46.3%, ranging from 10.5% in East Java to 66.9% in Jambi. Predominant breastfeeding, complementary feeding, and formula feeding rates were 14.3%, 8.6%, and 30.7%, respectively. Maternal unemployment was associated with a longer duration of breastfeeding (P=0.000). There were significantly more formula-fed infants who were undernourished compared to exclusively-breastfed infants (14% vs. 8%, P=0.001). There were also significantly more infants in the formula-fed group who had abnormal head circumference compared to those in the exclusively-breastfed group (9% vs. 6%, P=0.031). Child development, as assessed by the Pre-screening Developmental Questionnaire, was similar between the two groups (P=0.996).Conclusion The overall rate of exclusive breastfeeding in Indonesia is 46.3%. Maternal unemployment is associated with longer duration of breastfeeding. Exclusive breastfed infants have significant better growth and head circumference compared to formula fed infants, while the development is similar between the two groups.

Human milk feeding protects very low-birth-weight infants from retinopathy of prematurity: a pre–post cohort analysis

Objectives: To examine the effect of early human milk (HM) feeding on the incidence of retinopathy of prematurity (ROP) among very low-birth-weight (VLBW) infants.Methods: Observational cohort research in a Level III neonatal intensive care unit. A total of 186 infants were enrolled in this pre–post cohort study (114 infants were included in the HM-fed group and 72 in the formula-fed group). ROP, type of feeding (early exclusive HM versus any formula), and potential confounding variables were measured. Differences between groups were explored.Results: The clinical characteristics of the neonates did not differ between the two groups. By bivariate analysis, HM feeding was associated with 75% lower odds of Stage 2 or 3 ROP (OR = 0.25, 95% CI: 0.091 to 0.705; p = 0.009) At multivariate logistic regression, type of milk feeding retained significance, exclusive HM being protective with p = 0.002.Conclusions: This study found an association between early exposure to formula in VLBW infants and ROP. An initial HM diet, devoid of cow milk-containing products before achieving full enteral feeding, may help prevent ROP.

Sexually dimorphic response to feeding mode in the growth of infants

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.

Effect of Infant Formula Containing a Low Dose of the Probiotic Bifidobacterium lactis CNCM I-3446 on Immune and Gut Functions in C-Section Delivered Babies: A Pilot Study.

BACKGROUNDIn the absence of breast-feeding and its immunomodulatory factors, supplementation of starter infant formula (IF) with probiotics is currently used to support immune functions and gut development.AIMTo assess whether immune-related beneficial effects of regular dose (107 CFU/g of powder) of the probiotic Bifidobacterium lactis CNCM I-3446 (hereafter named B. lactis) in starter IF supplementation can be maintained with starter IF containing a low dose (104 CFU/g of powder) of B. lactis.METHODThis trial was designed as a pilot, prospective, double-blind, randomized, single-center clinical trial of two parallel groups (n = 77 infants/group) of C-section delivered infants receiving a starter IF containing either low dose or regular dose of the probiotic B. lactis from birth to six months of age. In addition, a reference group of infants breast-fed for a minimum of four months (n = 44 infants), also born by C-section, were included. All groups were then provided follow-up formula without B. lactis up to 12 months of age. Occurrence of diarrhea, immune and gut maturation, responses to vaccinations, and growth were assessed from birth to 12 months. The effect of low-dose B. lactis formula was compared to regular-dose B. lactis formula, considered as reference for IF with probiotics, and both were further compared to breast-feeding as a physiological reference.RESULTSData showed that feeding low-dose B. lactis IF provides similar effects as feeding regular-dose B. lactis IF or breast milk. No consistent statistical differences regarding early life protection against gastrointestinal infections, immune and gut maturation, microbiota establishment, and growth were observed between randomized formula-fed groups as well as with the breast-fed reference group.CONCLUSIONThis pilot study suggests that supplementing C-section born neonates with low-dose B. lactis-containing starter formula may impact immune as well as gut maturation similarly to regular-dose B. lactis, close to the breast-feeding reference.

Impact of different feeding patterns on mother-to-child transmission of hepatitis B virus

Objective To explore the effect of different feeding patterns on mother-to-child transmission of hepatitis B virus (HBV). Methods Chronic HBV-infected puerperae, who gave birth to a single baby at term in Beijing DiTan Hospital from December 18, 2010 to June 26, 2012, were recruited and separated into breast-feeding group and formula-feeding group according to the mother's will. Each group was then divided into three subgroups based on maternal serum HBV-DNA load before delivery: HBV-DNA negative subgroup (<5×102 copies/ml), low viral load subgroup (≥5×102 -<1.0×106 copies/ml) and high viral load subgroup (≥1.0×106 copies/ml). A total of 199 patients in breast-feeding group were divided into three subgroups, separately including 73, 62 and 64 patients, while a total of 210 patients in formula-feeding group into three subgroups, including 74, 62 and 74 patients. Newborns were injected with Hepatitis B hyper-immune globulin (HBIG) within 2 h after birth and at 15 to 30 days, followed by the routine injection of recombinant yeast derived Hepatitis B vaccine in accordance with the scheme of0, 1, 6 months. HBV-DNA was determined by fluorescence quantitative polymerase chain reaction, while serological markers of HBV by microsome chemiluminescence method. Comparisons were made between the breast-feeding and formula-feeding group on maternal background information, immune responses of the infants at one-month and seven-month old, the infectious status when they were between seven-month to two-year old. Statistical analysis was made with independent sample t-test, rank-sum test, χ2 test and Fisher's exact test. Results The HBeAg positive rates of puerperae in the three subgroups (HBV-DNA negative, low viral load and high viral load) among women of the breast-feeding group were 12.3% (9/73), 37.1% (23/62) and 96.9%(62/64), respectively, while 5.4% (4/74), 51.6% (32/62) and 95.9% (71/74) among the formula-feeding group. There was no significant difference between breast-feeding group and formula-feeding group (all P>0.05). Seventy of the 409 infants missed the follow-up at seven-month old, but returned between one to two years old. The anti-HBs positive rates of the three subgroups in infants of the breast-feeding group at seven-month old were 98.4% (61/62), 98.2% (54/55) and 95.7% (44/46), while 100.0% (63/63), 98.2% (56/57) and 92.9% (52/56) in the formula-feeding group (all P>0.05). The infection rate of infants in the breast-feeding group and the formula-feeding group were 3.0% (6/199) and 2.4% (5/210) at seven-month to two-year old. Notably, infected infants was identified in HBV-DNA negative subgroup in neither the breast-feeding group nor the formula-feeding group, while 0.0% (0/62) and 9.4% (6/64) of infection rate were reported in low viral load and high viral load subgroups of the breast-feeding group and 1.6% (1/62) and 5.4% (4/74) of the formula-feeding group (both P>0.05). Conclusion With combined immunization, breast-feeding in chronic HBV infected mothers does not increase the risk of infantile infection. Key words: Hepatitis B, chronic; Infectious disease transmission, vertical; Breast feeding; Feeding methods

La dieta crea nichos metabólicos en el "intestino inmaduro" que da forma a comunidades microbianas

Although diet composition has been implicated as a major factor in the etiology of various gastrointestinal diseases, conclusive evidence remains elusive. This is particularly true in diseases such as necrotizing enterocolitis where breast milk as opposed to commercial formula appears to confer a “protective effect” to the “immature gut.” Yet the mechanism by which this occurs continues to remain speculative. In the present study we hypothesize that the basic chemical composition of diet fundamentally selects for specific intestinal microbiota which may help explain disparate disease outcome and therapeutic direction. Complimentary animal and human studies were conducted on young piglets (21 d.)(n = 8) (IACUC protocols 08070 and 08015) and premature infants (adjusted gestational age 34-36 weeks) (n = 11) (IRB Protocol 15895A). In each study, cecal or stool contents from two groups (Breast milk-fed (BF) vs. Formulafed (FF)) were analyzed by gas chromatography/mass spectrometry (GC/MS) and comprehensive metabolic profiles generated and compared. Concurrently, bacterial community structure was assayed and respective representative microbiota of the groups determined by 16S rRNA gene amplicon pyrosequencing. Statistical modeling and analysis was done using SIMCA-P+ and R software. GC/MS metabolomics identified clear differences between BF and FF groups in the intestinal environment of piglets and humans. Sugars, amino-sugars, fatty acids, especially unsaturated fatty acids, and sterols were identified as being among the most important metabolites for distinguishing between BF and FF groups. Joint analysis of microbiota and metabolomics pinpointed specific sets of metabolites (p < 0.05) associated with the dominant bacterial taxa. The chemical composition of diet appears to have a significant role in defining the microbiota of the immature gut. Tandem analysis of intestinal microbial and metabolic profiles is potentially a powerful tool leading to better understanding of the role of diet in disease perhaps even leading to specific strategies to alter microbial behavior to improve clinical outcome.

충남 일부지역 초등학생의 영아기 영양법에 따른 식습관과 영양섭취상태

본 연구에서는 초등학생들을 영아기 영양법에 따라 모유영양군, 인공영양군, 혼합영양군으로 분류하여 영아기 영양법에 따른 식습관과 영양 섭취 상태를 비교?분석함으로써 영아기 영양법이 이후의 식사법에 미치는 영향을 살펴보고자 하였으며, 그 결과는 다음과 같다. 전체 조사대상자의 평균 연령은 9.7세였으며, 신장, 체중, 체질량지수는 각각 139.0cm, 34.6 kg, 17.8 kg/m2로 영아기 영양법에 따른 군간 유의한 차이가 없었다. 영아기 영양방법에 대해 조사한 결과 초유를 섭취한 비율은 모유영양군 97.2%, 혼합영양군 92.7%로 인공영양군의 40.9%보다 유의하게 높았으며(P<0.001), 이유 시기 및 첫 이유 식품에서 세 군간 유의한 차이는 보이지 않았다. 또한 식습관 조사 결과 간식을 전혀 먹지 않는다는 비율은 모유영양군 10.0%, 인공영양군 9.4%로 혼합영양군의 3.8%보다 유의하게 높았으며(P<0.05), 식사 및 외식 빈도 등은 군간 유의한 차이를 보이지 않았다. 총 식습관 점수와 에너지 및 영양소 섭취량은 영아기 영양법에 따른 군간 유의한 차이를 보이지 않았다. 이상의 연구 결과를 종합하여 볼 때 성장기 아동에서 영아기 영양법에 따라 간식 섭취 빈도, 우유?유제품 및 채소 섭취 정도 등과 같은 식습관이 다른 것으로 나타났으며, 추후 영아기 영양법에 따른 성장, 건강, 식습관 및 식사섭취상태 등에 대한 장기적인 추적조사가 필요할 것으로 사료된다.

Comparison of growth and nutritional status in infants receiving goat milk–based formula and cow milk–based formula: a randomized, double-blind study

ObjectiveTo compare the growth and nutritional status of infants fed goat milk–based formula (GMF) and cow milk–based formula (CMF).MethodsThe study was conducted in Beijing, China. It was a double-blind randomized controlled trial. A total of 79 infants aged 0–3 months old were recruited and randomized in GMF or CMF group. The infants were fed the allocated formula to 6 months. The weight, length, and head circumference were measured at the enrolment, 3 and 6 months. The start time and types of solid food were recorded. Blood elements, urinal, and fecal parameters were also tested.ResultsThe average weight of infants in the GMF group (mean±SD) was 4.67±0.99 kg and in the CMF group 4.73±1.10 kg at enrolment, and 8.75±0.98 kg (GMF) and 8.92±0.88 kg (CMF) at 6 months. There were no differences in the adjusted intention-to-treat analyses of weight, length, head circumference, and BMI z-scores between the two formula-fed groups over the 6-month study. Similarly, there were no remarkable differences in the timing and types of solid food, blood elements, urinal, and feces parameters, between the GMF and CMF group. No group differences have been shown in bowel motion consistency, duration of crying, ease of settling, or frequency of adverse events.ConclusionsGMF-provided growth and nutritional outcomes did not differ from those provided by CMF.