Infant Formula Research Articles

Should we be concerned about the use of lactose-free infant formulas?

Should we be concerned about the use of lactose-free infant formulas?

A Comparative Evaluation of the Acidogenic Potential of Lactose-based, Soy-based, Protein Hydrolysate-based, and Iron-based Milk Formulas Based on Dental Plaque pH, Salivary pH, and Buffering Capacity: An In Vivo Study.

Breastfeeding is the gold standard nutrition for infants. However, the inability of infants to latch on, maternal complaints of sore or painful nipples, and insufficient milk supply frequently result in early breastfeeding cessation. Hence, milk has subsequently been replaced by infant formula milks of high quality, which serve as an alternate source of nutrition for infants. There also has been a rising concern among parents and caretakers regarding the cariogenic potential of the various milk formulas available in the market due to the presence of fermentable carbohydrates in them, leading to an increase in nursing caries or early childhood caries. Hence, this study aims to comparatively evaluate the acidogenic potential of four different milk formulas based on dental plaque pH, salivary pH, and buffering capacity. This cross-sectional study was carried out to assess the acidogenic potential of various infant milk formulas using three main parameters of measurement of caries: evaluation of salivary pH, plaque pH, and buffering capacity.Baseline plaque and salivary pH and postconsumption plaque pH and salivary pH were assessed after 5, 10, 15, 20, 30, and 60 minutes in 60 healthy children (15 in each study group) aged 7-12 years after rinsing with group I (lactose-based), group II (soy-based), group III (protein hydrolysate-based), and group IV (iron-based) milk formulas. The pH was assessed using a precalibrated digital pH meter. Plaque pH was also further assessed based on its buffering capacity. Soy-based and protein hydrolysate-based milk formulas were found to be most cariogenic in both saliva and plaque. Lactose-based formulas were found to be the least cariogenic of all the milk formulas. Parents and caretakers must be made aware of the various types of milk formulas available, their composition, as well as their relative cariogenic nature. Feeding should always be supervised, and infants should not be left with milk-containing bottles as comforters. Milk feeds at bedtime, when salivary flow is reduced, should be discouraged. Dentists and pediatricians should be aware of the caries-related risk associated with different milk formulas before recommending them to children. Knowledge and awareness among parents and caretakers regarding the cariogenicity of various milk formulas available in the market. Mahanta A, Yadav G, Saha S, et al. A Comparative Evaluation of the Acidogenic Potential of Lactose-based, Soy-based, Protein Hydrolysate-based, and Iron-based Milk Formulas Based on Dental Plaque pH, Salivary pH, and Buffering Capacity: An In Vivo Study. Int J Clin Pediatr Dent 2024;17(8):851-859.

"Figure it out or starve": The Impact of an Infant-Formula Shortage on Prenatal Infant Feeding Intentions.

Beginning in February 2022, the United States faced an infant formula shortage that severely impacted access and affordability. Little is known about how this shortage impacted infant feeding intentions among expectant mothers. Our study sought to determine the impact of the formula shortage on prenatal feeding intentions and to understand expectant mothers' feelings and perceived stress related to the shortage. This cross-sectional, exploratory, observational study of pregnant women (n = 57) residing in New York City utilized a self-administered online survey in May-July 2022. The results indicate that ten (17.5%) respondents changed their feeding intentions during the infant formula shortage for months 0-3 or 3-6 of infancy to include more breastfeeding than originally intended. These mothers also reported significantly higher stress levels related to the shortage than their non-changing peers. Our results suggest that the formula shortage influenced feeding intentions among a subset of surveyed expectant mothers. The stress associated with the shortage influenced prenatal feeding intentions to include more breastfeeding than intended prior to the shortage. Prenatal healthcare providers should consider the availability of infant formula as one of myriad factors that influence infant feeding intentions, and that the stress associated with whether infant formula is readily available may influence these intentions as well.

Cronobacter sakazakii lysozyme inhibitor LprI mediated by HmsP and c-di-GMP is essential for biofilm formation and virulence.

Cronobacter sakazakii poses a significant threat, particularly to neonates and infants. Despite its strong pathogenicity, understanding of C. sakazakii biofilms and their role in infections remains limited. This study investigates the roles of HmsP and c-di-GMP in biofilm formation and identifies key genetic and proteomic elements involved. Gene knockout experiments reveal that HmsP and c-di-GMP are linked to biofilm formation in C. sakazakii. Comparative proteomic profiling identifies the lysozyme inhibitor protein LprI, which is downregulated in hmsP knockouts and upregulated in c-di-GMP knockouts, as a potential biofilm formation factor. Further investigation of the lprI knockout strain shows significantly reduced biofilm formation and decreased virulence in a rat infection model. Additionally, LprI is demonstrated to bind extracellular DNA, suggesting a role in anchoring C. sakazakii within the biofilm matrix. These findings enhance our understanding of the molecular mechanisms underlying biofilm formation and virulence in C. sakazakii, offering potential targets for therapeutic intervention and food production settings.IMPORTANCECronobacter sakazakii is a bacterium that poses a severe threat to neonates and infants. This research elucidates the role of the lysozyme inhibitor LprI, modulated by HmsP and c-di-GMP, and uncovers a key factor in biofilm formation and virulence. The findings offer crucial insights into the molecular interactions that enable C. sakazakii to form resilient biofilms and persist in hostile environments, such as those found in food production facilities. These insights not only enhance our understanding of C. sakazakii pathogenesis but also identify potential targets for novel therapeutic interventions to prevent or mitigate infections. This work is particularly relevant to public health and the food industry, where controlling C. sakazakii contamination in powdered infant formula is vital for safeguarding vulnerable populations.

Formula with large, milk phospholipid-coated lipid droplets in late-moderate preterm infants: a double-blind RCT.

Limited evidence exists on the preferred feeding method when breastfeeding is not possible in late and moderate preterm (LMPT) infants. This RCT evaluates growth, safety, and tolerance of a concept infant formula (IF) with large, milk phospholipid-coated lipid droplets enriched in dairy lipids in LMPT infants with primary objective to demonstrate non-inferiority of daily weight gain from randomization to 3 months corrected age compared to a standard IF. LMPT infants were randomized before or around term equivalent age to either the concept (n = 21) or standard IF (n = 20). Forty-one breastfed (BF) infants served as reference. Due to unintended low recruitment, non-inferiority in daily weight gain could not be demonstrated for the Concept compared to the Control group, but was compared to the BF group. Other outcomes were similar between the formula groups, except for an apparent larger head circumference gain in the Concept group. No apparent differences in growth and body composition outcomes were observed between the Concept and BF reference groups. This small-scale study suggests the concept IF is a safe alternative for parents who choose IF to feed their LMPT infant. Larger trials are needed to better determine impacts on head growth or body composition. In a small group of late and moderate preterm infants, growth from randomization until 3 months corrected age of infants fed with a concept infant formula with large, milk phospholipid-coated lipid droplets was not -significantly different from infants fed a standard infant formula. Infants in the Concept group had non-significant larger gain in head circumference compared to the Control group; larger trials are needed to confirm this finding. Both formulas were well-tolerated, with no differences in adverse events. The concept formula is potentially a safe alternative for parents of moderate to late preterm infants who choose to use formula milk.

Isolation of Pathogenic Cronobacter Species as Bacteriological Risks Indicator in Powdered Infant Formula Available to Deprived Infants in Lagos Metropolis, Nigeria.

Powdered infant formula (PIF) is rich in nutrients that support the survival and growth of bacteria that trigger food safety disorders in deprived infants through life-threatening illnesses. The study aims to examine and identify the incidence of pathogenic bacteria of concern in PIF upon reconstitution in lukewarm water. A total of 172 samples consisting of 38 brands of PIF available in the Lagos metropolis were sampled, suspended in water (10g in 100mL), and bacteria strains were isolated using combinational enrichment and selective culture techniques. Pure bacterial strains were characterized and identified based on their physiology and 16S rRNA gene sequence homology. While 85 bacterial strains were isolated from the enriched culture system, 20 strains were selectively isolated based on tolerance to sodium deoxycholate. Approximately 13% of the selected bacteria were identified as Cronobacter spp., exhibiting virulence traits including extracellular protease production, coagulation and proteolysis of casein, haem-agglutination, and β-haemolysis of human blood. Approximately 82% of the Cronobacter strains tolerated NaCl (10%) and bile salt; and exhibited resistance to cefotaxime, ceftriaxone, gentamicin, and Amoxicillin-clavulanic acid antibiotics. The presence of Cronobacter spp. in 13% of the PIF brands available to infants calls for concern about the safety of deprived infants that might be fed with such PIF. Consequently, PIF safety alerts need to be activate while further studies on critical points at which the pathogens get introduced to the PIFs need to be identified.

Draft genome sequence of Bacillus cereus sequence type 2255 isolated from powdered infant formula.

The draft genome sequence of a Bacillus cereus strain, DFPST-SP1, isolated from powdered infant formula in the United States is reported. The 5,216,828-bp draft genome comprises 46 contigs with 66.4× coverage and 36% GC content and was typed as sequence type 2255.

Using integrated transcriptomics and metabolomics to explore the effects of infant formula on the growth and development of small intestinal organoids.

Infant formulas are designed to provide sufficient energy and the necessary nutrients to support the growth and development of newborns. Currently, research on the functions of formula milk powder focuses on clinical research and cell experiments, and there were many cell experiments that investigated the effect of infant formulas on cellular growth. However, most of the cells used are tumor cell lines, which are unable to simulate the real digestion process of an infant. In this study, we innovatively proposed a method that integrates human small intestinal organoids (SIOs) with transcriptomics and metabolomics analysis. We induced directed differentiation of human embryonic stem cells into SIOs and simulated the intestinal environment of newborns with them. Then, three kinds of 1-stage infant formulas from the same brand were introduced to simulate the digestion, absorption, and metabolism of the infant intestine. The nutritional value of each formula milk powder was examined by multi-omics sequencing methods, including transcriptomics and metabolomics analysis. Results showed that there were significant alterations in gene expression and metabolites in the three groups of SIOs after absorbing different infant formulas. By analyzing transcriptome and metabolome data, combined with GO, KEGG, and GSEA analysis, we demonstrated the ability of SIOs to model the different aspects of the developing process of the intestine and discovered the correlation between formula components and their effects, including Lactobacillus lactis and lactoferrin. The study reveals the effect and mechanisms of formula milk powder on the growth and development of infant intestines and the formation of immune function. Furthermore, our method can help to construct a multi-level assessment model, detect the effects of nutrients, and evaluate the interactions between nutrients, which is helpful for future research and development of infant powders.

Complementary Feeding in the Clinical Practice: An Exploratory Survey among Italian Primary Care Pediatricians.

Introduction: Complementary feeding (CF) is the process of introducing solid or liquid foods (complementary foods, CFs) other than human breast milk (HBM) or infant formula into infants' diet when HBM or infant formula is no longer sufficient to meet infants' nutritional needs. Primary care pediatricians (PCPs) are paramount in guiding and educating infants' families during CF. Materials and Methods: Our exploratory survey aimed to investigate PCPs' current clinical approach to managing CF. From 1 March 2024 to 30 April 2024, a digital questionnaire composed of 32 multiple-choice questions investigating PCPs' attitudes toward CF in healthy, full-term infants was proposed to 1620 PCPs contacted through scientific societies. Results: The questionnaire was completed voluntarily; 707 PCPs (79.5% female, 66.1% aged over 50 years) fully responded to the survey in the proposed timeframe (participation rate 43.6%). Among the responders, 47.5% recommended traditional CF; 42.1% declared to know the baby-led weaning (BLW) approach and on-demand CF (ODCF), but only 32.8% and 12.5% of them recommended these types of CF, respectively. The vast majority (95%) of participants recommended that CF start between 4 to 6 completed months of age. CF routinely based on vegetarian or plant-based diets was supported by 45/707 (6.1%), only if planned by a specialist by 253/707 (35.8%), and only upon request by caregivers by 257/707 (36.3%). Egg and fish introduction was mostly advised in the first year of life, although in case of a positive family history of food allergy, 13.3% of participants recommended the introduction of egg and fish after 12 months. Conclusions: In conclusion, PCPs did not display a homogenous approach to CF; further studies and educational programs are needed to achieve more flexibility and knowledge on this important nutritional issue.

Antimicrobial effect of lactoferrin and glycerol monolaurate on selected bacteria associated with newborn infections

Human breast milk contains a rich array of bioactive substances, such as immunoglobulins, lactoferrin antimicrobial peptides, and glycerol monolaurate, which play a crucial role in providing immune protection to infants. Infant formula manufacturers strive to match mother's milk's nutritional makeup, including immune-boosting ingredients. Lactoferrin and glycerol monolaurate (GML) are important antibacterial compounds in human milk. The study aimed to investigate the effect of bovine lactoferrin (bLf) and GML in preventing the growth of inoculated bacteria into infant formula. The study examined both individual and combined use of these components. The bacteria that were tested included: 1) Gram-negative bacteria: Cronobacter sakazakii strains 12868 and 29004, Pseudomonas aeruginosa, Salmonella enterica Typhimurium, and 2) Gram-positive bacteria: Methicillin-resistant Staphylococcus aureus (MRSA), and Listeria monocytogenes. The result of the agar diffusion assays showed that bLf, at a concentration of 16 mg/disc, exhibited strong inhibition (≥20 mm) of all the selected bacterial strains. On the other hand, GML at a concentration of 8 mg/disc showed strong inhibition of all strains; however, Gram-positive bacteria were more susceptible, so a concentration of 5 mg/disc was enough to achieve strong inhibition of these strains. The minimal bactericidal concentrations (MBC) analysis aimed to achieve a >3-log reduction in the growth of various bacterial strains. The results showed that S. enterica Typhimurium and L. monocytogenes were more susceptible to bLf than the other strains (MBC: 7 and 4.8 mg/ml, respectively, vs. 14.9–18.4 mg/ml for the other strains). In contrast, MRSA and L. monocytogenes were more susceptible to GML (MBC: 6 and 10 mg/ml, respectively, vs. 16–18 mg/ml for Gram-negative strains). The results of reconstituted powdered infant formulas (RPIF), with the addition of bLf, GML, or both at pathogen-specific MBC, showed significant log reductions in the growth of experimentally inoculated bacteria compared to the control at different time intervals. All bacterial strains exposed to bLf and GML exhibited >3-log reduction within 72 h, with Gram-positive strains showing >7-log reduction. GML and bLf combined had a stronger anti-bacterial activity than individual components, indicating the potential of combining GML and bLf as natural agents against specific pathogenic bacteria. Future studies are needed to understand the potential use of these compounds in different food matrices and clinical settings.

Risk Factors for Salmonella Infection in Children under Five Years: A Hospital-Based Study in Kilimanjaro Region, Tanzania.

Salmonella is among the causative agents for diarrhea worldwide, but its risk factors in Tanzanian children are poorly understood. A hospital-based cross-sectional study was conducted in Moshi, Kilimanjaro region, from July 2020 to November 2022 among children under five admitted with diarrhea. A questionnaire was administered to all parents/caretakers of the enrolled children. Logistic regression was utilized to analyze the risk factors, with significance at p < 0.05. A total of 306 children were enrolled in the study. The median age was 13.8 months (IQR 8.4-21.8). The majority (58.5%) were males, and 59.5% were from rural areas. Salmonella was identified in eight (2.6%) stool samples, with a higher prevalence in urban than rural areas (4.8% vs. 1.1%; p-value = 0.044). The significant risk factors associated with Salmonella infection among the children included consuming raw milk (adjusted OR = 30.19; 95% CI: 3.94-231.46), using infant formula (adjusted OR = 15.78; 95% CI: 2.98-83.56), undisclosed household income (adjusted OR = 9.98; 95% CI: 2.46-40.12), purchasing eggs direct from the farms (adjusted OR = 7.58; 95%CI: 1.31-43.96), and contact with chickens (adjusted OR = 6.49; 95%CI: 1.25-33.59). These findings highlight the need for targeted interventions to improve food safety, hygiene practices, and socioeconomic conditions.

Close Relations, Practitioners or Social Networks: What Affects the Selection of Infant Formula Products?

This study examines which factors influence the preferences of mothers seeking advice on the use of infant formula in feeding practices. The effects of their close social circle, medical professionals and social network forums on feeding choices were evaluated. Data were collected from 638 questionnaires from mothers and were statistically analyzed. Our findings suggest that age may influence the preference to seek advice from a close social circle over consulting with medical professionals (p-value = 0.019 < 0.05). The educational level and the number of children impact the preferences of using infant formula over combining it with breastfeeding (p-value = 0.000 < 0.05 and p-value = 0.004 < 0.05, respectively). The research contributes to the understanding of the complex interplay between various demographic and socioeconomic factors and the decision-making process of mothers based on multiple social and digital sources of influence. The research presents valuable insights for healthcare policymakers and professionals in supporting mothers and providing them with up-to-date information. Feeding information can be distributed through all the communication channels that were examined in this study to benefit different socio-economic groups and to contribute to the well-being of infants in the long-run.

Transcriptomics analysis of the role of SdiA in desiccation tolerance of Cronobacter sakazakii in powdered infant formula

The quorum-sensing receptor SdiA is vital for regulating the desiccation tolerance of C. sakazakii, yet the specific mechanism remains elusive. Herein, transcriptomics and phenotypic analysis were employed to explore the response of C. sakazakii wild type (WT) and sdiA knockout strain (ΔsdiA) under drying conditions. Following 20 days of drying in powdered infant formula (PIF), WT exhibited 4 log CFU/g higher survival rates compared to ΔsdiA. Transcriptome revealed similar expression patterns between csrA and sdiA, their interaction was confirmed both by protein-protein interaction analysis and yeast two-hybrid assays. Notably, genes associated with flagellar assembly and chemotaxis (flg, fli, che, mot regulon) showed significantly higher expression levels in WT than in ΔsdiA, indicating a reduced capacity for flagellar synthesis in ΔsdiA, which was consistent with cellular morphology observations. Similarly, genes involved in trehalose biosynthesis (ostAB, treYZS) and uptake (thuEFGK) exhibited similar expression patterns to sdiA, with higher levels of trehalose accumulation observed in WT under desiccation conditions compared to ΔsdiA. Furthermore, WT demonstrated enhanced protein and DNA synthesis capabilities under desiccation stress. Higher expression levels of genes related to oxidative phosphorylation were also noted in WT, ensuring efficient cellular ATP synthesis. This study offers valuable insights into how SdiA influences the desiccation tolerance of C. sakazakii, paving the way for targeted strategies to inhibit and control this bacterium.

Protein-bound and free glycation compounds in human milk: A comparative study with minimally processed infant formula and pasteurized bovine milk

The role of the Maillard reaction and the accumulation of non-enzymatic glycation compounds in human milk have been scarcely considered. In this study, we investigated the proteins most susceptible to glycation, the identity of the corresponding modified residues and the quantitative relationship between protein-bound and free glycation compounds in raw human milk and, for comparison, in minimally processed infant formula and pasteurized bovine milk. In human milk, total protein-bound lysine modifications were up to 10% of the counterparts in infant formula, while Nε-carboxymethyllysine reached up to 27% of the concentration in the other two products. We demonstrated that the concentration of free pyrraline and methylglyoxal-hydroimidazolone were of the same order of magnitude in the three milk types. Our results delineate how the occurrence of some glycation compounds in human milk can be an unavoidable part of the breastfeeding and not an exclusive attribute of infant formulas and pasteurized bovine milk.

Chloropropanols and Their Esters in Food: An Updated Review.

Chloropropanols, their fatty acid esters, and glycidol and its fatty acid esters (GEs) are process contaminants in foods that pose potential health risks. These contaminants typically arise during the deodorization process of vegetable oils, particularly in high concentrations within oils like palm oil and products derived from them, such as margarine, baked goods, pastries, and infant formula. Chloropropanol esters and GE can hydrolyze under the influence of lipases, forming chloropropanols. Elevated temperatures during food production can lead to the release of free 3-chloro-1,2-propanediol (3-MCPD) or free 2-chloro-1,3-propanediol (2-MCPD) in products containing both fat and salt. The exposure to these contaminants, especially for infants and young children, raises concerns about potential health hazards. While extensive research has focused on 3-MCPD, 2-MCPD, and GE, knowledge regarding other chloropropanols such as 1,3-dichloro-2-propanol (1,3-DCP), 2,3-dichloro-1-propanol (2,3-DCP), and their fatty acid esters remains limited. This review aims to provide a comprehensive overview encompassing formation mechanisms, analysis methods, toxicological implications, occurrence patterns, exposure levels, mitigation strategies, and legislative considerations concerning these contaminants.

Human milk vs. Infant formula digestive fate: In vitro dynamic digestion and in vivo mini-piglet models lead to similar conclusions

Infant formula (IF), the only nutritionally adequate substitute for human milk (HM), still needs to be improved to be more biomimetic with HM, including in terms of digestive fate. The latter can be explored using different digestion models. The present study aimed to compare IF and HM digestion using in vivo (mini-piglet) and in vitro (dynamic system, DIDGI®) models. Fresh mature HM was collected and compared with a standard bovine IF. In vivo, 18 Yucatan mini-piglets (24-day-old) received HM or IF and were euthanized 30 min after the last meal. The entire digestive content was collected from the stomach to the colon. In vitro, the same meals were fed to an in vitro dynamic digestion model simulating the term infant at four weeks of age. Digesta were sampled regularly in the gastric and intestinal compartments. Structure (confocal microscopy and laser light scattering) and proteolysis (SDS-PAGE for residual intact proteins, OPA for hydrolysis degree, LC-MS/MS for peptides) were investigated along digestion. The digesta microstructure differed between HM and IF in a similar way between in vitro and in vivo digestion. In vitro gastric proteolysis of caseins and α-lactalbumin was significantly slower for HM than for IF, such as for the early intestinal proteolysis degree. In vitro bioaccessibility of free AAs explained only 30 % of the true ileal digestibility of AAs. Peptide mapping of caseins differed between HM and IF along their digestion. The relative peptide mapping data over six proteins from HM and IF were highly correlated between in vitro and in vivo digestion, particularly at 80 and 120 min of in vitro gastric digestion vs. in vivo stomach data and at 20 and 40 min of in vitro intestinal digestion vs. in vivo proximal jejunum data (r = 0.7–0.9, p < 0.0001, n = 1604). 40 to 50 % of the bioactive peptides identified in vivo were also found in vitro, with a good correlation of their abundances (r = 0.5, p < 0.0001, n = 61). Overall, in vitro and in vivo digestion were in good agreement, both indicating a different digestive fate for HM and IF.

Bifidobacterium longum subsp. infantis YLGB-1496-Toxicological evaluation.

Bifidobacterium infantis YLGB-1496, originally isolated from breast milk from a Taiwanese mother, is under study for use as a probiotic. As part of safety assessment, an Ames, in vivo mouse micronucleus, and in vivo mouse spermatocyte chromosome aberration assay were conducted along with a 13-week oral rat toxicity study. B.infantis YLGB-1496 had no activity in any of the genotoxicity assays. Administration of the bacteria to Sprague-Dawley rats at doses ranging from 0 to 1.5 g/kg bw/day had no treatment-related effects on any of the endpoints measured. There appear to be no concerns for translocation or pathogenicity of B.infantis YLGB-1496 based on extensive experience with the species in general. The results of the current investigations support potential use of B.infantis YLGB-1496 as a probiotic in infant formula.

Variations in the Sensory Attributes of Infant Formula among Batches and Their Impact on Maternal Consumer Preferences: A Study Combining Consumer Preferences, Pivot Profile, and Quantitative Descriptive Analysis.

The sensory quality of infant formula (IF) has a significant impact on the preferences and purchasing behavior of maternal consumers. Consumer-based rapid descriptive methods have become popular and are widely preferred over classical methods, but the application of Pivot Profile (PP) in IF is still little explored. In this study, both Pivot Profile (PP) and Quantitative Descriptive Analysis (QDA) were applied to characterize the sensory profile of 12 batches of one-stage and three-stage IF with different storage periods, respectively, along with consumer preference data to determine the flavors contributing to liking. The results of PP and QDA aligned moderately well, with the most perceptible differences identified as "fishy", "milky", and "T-sweet" attributes. IFs with shorter storage times were highly associated with "milky" aromas and "T-sweet" tastes, whereas IFs with longer storage times exhibited a strong correlation with "fishy" and "oxidation" aromas. External preference analysis highlighted that the occurrence of "fishy" and "oxidation" aromas during prolonged storage periods significantly reduced the consumer preference for IFs. Conversely, the perception of "milky" and "creamy" aromas and "T-sweet" tastes may be critical positive factors influencing consumer preference. This study provided valuable insights and guidance for enhancing the sensory quality and consumer preference of IF.

Infant formula donations and code violations during earthquake relief efforts in Türkiye in 2023: an observational study

BackgroundOn 6 February 2023, an Mw 7.8 earthquake struck southern and central Türkiye and north-western Syria, affecting the lives of 4.6 and 2.5 million children, respectively. In such crises, infants who are dependent on commercial milk formula (CMF) face increased vulnerability to diseases and malnutrition as safe preparation of CMF becomes difficult and sometimes impossible. The Operational Guidance on Infant and Young Child Feeding in Emergencies (OG-IFE) provides guidance on protecting and supporting recommended infant and young child feeding and minimizing the risks that come with CMF feeding. In addition, the International Code of Marketing of Breastmilk Substitutes (the Code) ensures adequate nutrition for infants by protecting and promoting breastfeeding and ensuring the proper usage of CMF. This study aims to document violations of the Code and the OG-IFE during the earthquake relief efforts to help strengthen infant and young child feeding emergency responses and inform future disaster relief policies.MethodsData was collected from 6 February to 10 March 2023 through Internet sources. Social media, news websites, and the Emergency Nutrition Network forum were used for data collection. Turkish content was translated into English for analysis, with a focus on donation-related information and Code violations related to baby food and infant feeding.ResultsA total of 40 reports on CMF, complementary food, and feeding equipment donations were collected. Three main types of violations of the OG-IFE and the Code were identified, with the majority of them being incidences of individuals, humanitarian organizations, and government agencies seeking or accepting donations. Infant formula companies continued to violate the Code by donating large quantities of CMF and feeding equipment to the Turkish Red Crescent, government agencies, and disaster relief infant and young child feeding (IYCF) coordination authorities.ConclusionsThese incidents reflected a systematic violation of the Code and non-compliance with the OG-IFE. Globally accepted IYCF standards and recommendations were not consistently followed due to fragmented early responses. There is a critical need to step up efforts to ensure appropriate and safe IYCF practice protecting and supporting breastfed and non-breastfed infants in emergencies.

Assessment of the reliability of at-home caregiver-collected anthropometric measurements.

Anthropometric measurements provide valuable information about infant growth patterns and can help identify nutrition, growth, and developmental concerns. With the increasing use of telehealth and decentralized clinical trial approaches, there is potential for caregivers to collect anthropometric measurements at home via teleconference with healthcare providers (HCPs) to monitor infant growth, which indirectly reflects health status. This study aimed to evaluate whether telehealth-guided caregivers can utilize standardized methods and home-use measurement equipment to collect reliable anthropometric measurements compared to HCPs and study nurses. The study compared the weight, length, and head circumference measurements collected by caregivers (n = 8 pairs), pediatric HCPs (n = 7), and study nurses (n = 4), who served as the gold standard comparator group. Four silicone dolls with varied anthropometrics were used as surrogates for human infants. Caregiver inter- and intra-observer technical errors of measurement (TEMs) were all equal to or below the maximum allowed error (MAE). For HCPs, only intra-observer TEM for length and inter-observer TEM for HC and length were within the MAE. There was no evidence of bias for either caregiver or HCP measurements compared to the gold standard. Coefficients of reliability (R) were greater than 0.96 for all measurements. Preliminary results from this study demonstrate that telehealth-guided caregivers can capture accurate and reliable anthropometric measurements compared to HCPs. The results suggest that remote measurement collection allows for more frequent monitoring while reducing the burden on patients and caregivers in primary care and clinical trials such as infant formula growth monitoring studies.