Use Of Infant Formula Research Articles

Infant formula feeding practices in a prospective population based study.

BackgroundIt is recommended that formula-fed infants are given standard whey-based infant formula throughout the first year of life, unless otherwise advised by healthcare professionals. To our knowledge it has not yet been explored if parents are using a whey-based infant formula throughout the first 12 months of life. Reasons for parental choice of formula are also unknown. Therefore, the objective of this paper was to describe parental administration of whey-based and non whey-based infant formula in the first year of life.MethodsData collected as part of the Cork BASELINE Birth Cohort Study examined infant feeding practices at 2, 6 and 12 months of age. Descriptive analysis explored infant feeding practices and parental reasons for changing from a whey-based to a non whey-based infant formula. Multiple logistic regression investigated parental and infant characteristics associated with the use of whey-based infant formula.ResultsIn total, 62.4%, 40.4% and 12.8% parent(s) at 2, 6 and 12 months, respectively, gave their infant whey-based infant formula. No parental or infant characteristic was found to consistently influence the use of whey-based infant formula. The most common reason reported by parent(s) for changing their infant’s formula to a non whey-based formula was that they perceived their baby as being hungry.ConclusionThe majority of parent(s) commence their infants on whey-based formula, but most change to non whey-based formula before 12 months of age. Parental perception of infant satiety and not healthcare advice was the most common reason for changing from a whey-based to a non whey-based infant formula. Additional research is now required to investigate the effect of whey-based and non whey-based infant formula on infant growth.

Diversification alimentaire du nourrisson. Évaluation des pratiques en regard des recommandations françaises actuelles chez les pédiatres varois et les internes affectés à la faculté d’Aix-Marseille

To assess the practices of pediatricians in relation to current recommendations of the French Society of Pediatrics on infant food diversification. This was an observational study conducted from 1 November 2014 to 31 March 2015. The study population consisted of 97pediatricians in the Var department and 84pediatric residents assigned to the University of Aix-Marseille in France. A questionnaire was sent by email or post to determine physician characteristics, food diversification methods in healthy children and those at atopic risk, and how the pediatric consultation was conducted. The expected answers were based on the most recent recommendations of the French Society of Pediatrics published in 2008, updated from 2003. In summary, breastfeeding is recommended up to 6months. Food diversification can be started between 4 and 6months in children with no allergy risk. Gluten, honey, legumes and cow's milk are introduced between 4 and 7months, after 12months and after 36months, respectively. In atopic children, food diversification is delayed until after 6months and the most allergenic foods (nuts, exotic fruits, peanuts, and shellfish) are introduced after the age of 12months. Eighty-four responses were obtained (51%): 50pediatricians and 34pediatric residents. Sixteen items were classified depending on whether or not an update after 2003 existed. Over 80% of the physicians responded as recommended for the recently updated items for the age of introduction of "solid food in healthy children", "gluten", "cow's milk protein hydrolysates", and "the time until introduction of cow's milk in the atopic child". At best, 65% of physicians responded in accordance with recommendations for items without a recent update, age of introduction of "cow's milk", "milk desserts", "animal proteins", "fats", "vegetables", "use of a hypoallergenic infant formula", and "breastfeeding extension with atopic child". Pediatric residents had the same responses as pediatricians. Seventy-two physicians did not consider the allergenic status of the children to delay the introduction of the most allergenic foods. The lack of complete updating the introduction of solid foods schedule could explain the differences between pediatrician practices and recommendations. Moreover, old recommendations on allergenic food eviction are still available. Pediatricians and pediatric residents partially applied the current recommendations on the introduction of solid food.

Racial and Ethnic Differences in Breastfeeding

Breastfeeding rates differ among racial/ethnic groups in the United States. Our aim was to test whether racial/ethnic disparities in demographic characteristics, hospital use of infant formula, and family history of breastfeeding mediated racial/ethnic gaps in breastfeeding outcomes. We analyzed data from the Community and Child Health Network study (N = 1636). Breastfeeding initiation, postnatal intent to breastfeed, and breastfeeding duration were assessed postpartum. Hierarchical linear modeling was used to estimate relative odds of breastfeeding initiation, postnatal intent, and duration among racial/ethnic groups and to test the candidate mediators of maternal age, income, household composition, employment, marital status, postpartum depression, preterm birth, smoking, belief that "breast is best," family history of breastfeeding, in-hospital formula introduction, and WIC participation. Spanish-speaking Hispanic mothers were most likely to initiate (91%), intend (92%), and maintain (mean duration, 17.1 weeks) breastfeeding, followed by English-speaking Hispanic mothers (initiation 90%, intent 88%; mean duration, 10.4 weeks) and white mothers (initiation 78%, intent 77%; mean duration, 16.5 weeks); black mothers were least likely to initiate (61%), intend (57%), and maintain breastfeeding (mean duration, 6.4 weeks). Demographic variables fully mediated disparities between black and white mothers in intent and initiation, whereas demographic characteristics and in-hospital formula feeding fully mediated breastfeeding duration. Family breastfeeding history and demographic characteristics helped explain the higher breastfeeding rates of Hispanic mothers relative to white and black mothers. Hospitals and policy makers should limit in-hospital formula feeding and consider family history of breastfeeding and demographic characteristics to reduce racial/ethnic breastfeeding disparities.

Factors associated with the initiation of breastfeeding within the first 48 hours of life in Tabuk, Saudi Arabia.

BackgroundThe identification of the factors most closely associated with the initiation of breastfeeding is a vital first step in designing strategies to promote breastfeeding. The study therefore aimed to identify the factors that may be associated with the initiation of breastfeeding in the first 48 h after giving birth among mothers in Tabuk, Saudi Arabia.MethodsThis cross-sectional study was based on a sample of 671 mothers of infants aged up to 24 months at five primary healthcare centers between May and September 2015. A structured questionnaire was used to gather general sociodemographic data along with more detailed information on breastfeeding. A logistic regression analysis was then performed to establish the factors which were independently associated with the mothers’ initiation of breastfeeding.ResultsBreastfeeding was initiated by 92.7 % of mothers within the first 48 h after childbirth. Breastfeeding initiation within the first 48 h of childbirth was lower in women who gave birth by caesarean section (Adjusted Odds Ratio [AdjOR] 0.31, 95 % Confidence Interval [CI] 0.17, 0.57), and had preterm (AdjOR 0.29, 95 % CI 0.12, 0.70) or low birth weight infants (AdjOR 0.35, 95 % CI 0.17, 0.75).ConclusionsEach variable presents an important barrier to breastfeeding initiation. Suitable hospital policies and staff training are needed to support mothers in quickly initiating breastfeeding, and to discourage the use of infant formula in hospital. To encourage higher rates of exclusive breastfeeding in Saudi Arabia, additional support is required for mothers at a higher risk of failing to initiate breastfeeding in a timely manner.

Prevalência e fatores associados à prescrição/solicitação de suplementação alimentar em recém-nascidos

RESUMO Objetivo Identificar a prevalência da utilização de suplemento alimentar em recém-nascidos e avaliar as características, os solicitantes e os motivos justificados para sua utilização em um "Hospital Amigo da Criança". Métodos Trata-se de estudo do tipo transversal, realizado com 113 díades mãe e filho de um hospital universitário com o título de "Amigo da Criança", no período de agosto de 2012 a fevereiro de 2013. A partir de um questionário estruturado, foram coletadas informações sociodemográficas, antecedentes obstétricos, condições de nascimento da criança, características do suplemento e prescritores. Foi realizada análise descritiva e inferencial (teste Qui-quadrado de Pearson), aceitando um nível de significância p?0,05, com intervalo de confiança de 95%. Resultados A prevalência de indicação de suplemento alimentar foi de 16,0%, com menor aderência para os nascidos nas primeiras horas do dia (p=0,006). O profissional de enfermagem foi o que mais solicitou o suplemento (54,0%), e no menor tempo (1 a 6 horas) após o nascimento da criança (p=0,05). Quanto aos motivos de indicação, apenas 6,2% atenderam às recomendações da Iniciativa Hospital Amigo da Criança, destacando-se a hipogalactia como principal motivo (71,7%), com maior probabilidade de indicação para os recém-nascidos de parto cesáreo (p<0,02). Conclusão Apesar do título de "Hospital Amigo da Criança", foram identificadas inúmeras indicações de suplemento ali-mentar desnecessárias e precipitadas, o que pode dificultar o aleitamento materno e favorecer o desmame precoce, sugerindo a necessidade de uma avaliação mais criteriosa na indicação pela equipe assistencial.

The supplemental use of infant formula in the context of universal breastfeeding practices in Western Nepal.

BackgroundWhile the initiation of breastfeeding is universal in Nepal, little has been reported on formula feeding practices. This study aimed to report the prevalence of, and factors associated with, the use of infant formula as supplementary feeds in the Western region of Nepal.MethodsA community-based cohort study was conducted to collect infant feeding information among 735 postpartum mothers using structured questionnaires. Complete formula feeding data were collected from 711 women in the first, fourth and sixth month postpartum. Factors independently associated with formula feeding were investigated using multiple logistic regression.ResultsAll mothers were breastfeeding their infants at the time of recruitment. The prevalence of formula feeding was 7.5 % in the first month and 17 % in the sixth month. About a quarter of mothers (23.8 %) reported providing infant formula at least once during the first six months of life. Infant formula was used commonly as top-up food. Stepwise logistic regression showed that infants born to families residing in urban areas (adjusted odds ratio (aOR): 2.14; 95 % confidence interval (CI): 1.37 to 3.33), mothers with higher education (aOR: 2.08; 95 % CI: 1.14 to 3.80), and infants born by caesarean section (aOR: 1.96; 95 % CI: 1.21 to 3.18) were at greater risk of formula feeding.ConclusionThe current findings indicate that health workers should support mothers to initiate and continue exclusive breastfeeding particularly after caesarean deliveries. Furthermore, urban health programs in Nepal should incorporate breastfeeding programs which discourage the unnecessary use of formula feeding. The marketing of formula milk should be monitored more vigilantly especially in the aftermath of the April 2015 earthquakes or other natural disasters.

Growth and Tolerance of a Routine Infant Formula with an Alternative DHA Source Fed to Term Infants

BackgroundDocasahexaenoic (DHA) and arachidonic acid (ARA) are long‐chain polyunsaturated fatty acids (LCPUFAs) important for fetal and infant development. When fed at concentrations based on worldwide human milk composition, DHA in infant formula is related to visual and cognitive development in term infants and has resulted in red blood cell (RBC) LCPUFA concentrations comparable to breastfed infants1,2. Commercially available algal‐derived DHA single cell oil (DHASCO) is generally recognized as safe (GRAS) for use in and at certain levels specified for infant formula. DHASCO also has a long history of safe use in infant formula. Recently, a new DHA‐rich single cell oil (DHASCO‐B) from an alternative marine algae source achieved GRAS status for a similar use.ObjectiveThe objective of this study was to establish that the investigational cow's milk‐based formula with an alternative DHA source (DHASCO‐B) compared to the marketed formula with the current DHA source (DHASCO; Control) provides adequate growth and dietary bioequivalence with respect to DHA.MethodsIn this multi‐center, double‐blind, randomized, controlled, parallel‐group, prospective study, infants received one of two study formulas with DHA at 17 mg/100 kcal: Control (n=140) or an investigational formula (DHASCO‐B, n=127). The primary outcome was growth rate from 14 to 120 days. Growth rates were analyzed by gender using ANOVA. A blood sample was collected at 120 days of age in a subset of participants (Control, n =34; DHASCO‐B, n=27). DHA and ARA concentrations in RBC (μg/mL) were assessed by capillary column gas chromatography. A 90% confidence interval (CI) was calculated for the ratio of the group mean (geometric) total RBC DHA concentration.ResultsThere were no group differences in infant demographic or anthropometric characteristics at enrollment or study completion rate. No significant group differences were observed for weight, length, or head circumference growth rates by gender from 14 to 120 days of age. The calculated CI for total RBC DHA concentration for the investigational relative to the Control group (91 to 104%) fell within the pre‐specified equivalence limit (80 to 125%). No statistically significant differences (P<0.05) in total RBC DHA or ARA concentrations (μg/ml) (DHA: Control, 90.2 ±2.31; DHASCO‐B, 88.1 ±2.59 and ARA: Control, 243.6 ±4.68; DHASCO‐B, 240.8 ±5.25) or percent of total fatty acids (wt/wt) (DHA: Control, 5.52 ±0.12; DHASCO‐B, 5.52 ±0.13 and ARA: 14.90 ±0.24, DHASCO‐B: 15.15 ±0.27) were detected.ConclusionsResults of this study demonstrated the investigational formula provided adequate growth and dietary bioequivalence when fed to healthy term infants from 14 to 120 days of age compared to the control formula with the traditional source of DHA.Support or Funding InformationAC Patterson, KH Maditz, J Wampler, C Harris, A Kirchoff, and CL Berseth are full‐time employees of Mead Johnson Nutrition.

Excessive weight loss in exclusively breastfed full-term newborns in a Baby-Friendly Hospital

ObjectiveTo determine the risk factors for weight loss over 8% in full-term newborns at postpartum discharge from a Baby Friendly Hospital. MethodsThe cases were selected from a cohort of infants belonging to a previous study. Healthy full-term newborns with birth weight ≥2.000g, who were exclusively breastfed were included and excluded twins and those undergoing phototherapy as well as those discharged after 96h of life. The analyzed maternal and neonatal variables were maternal age, parity, ethnicity, type of delivery, maternal diabetes, gender, gestational age and appropriate weight for age. Adjusted multiple and univariate Cox regression analyses were used, considering as significant p<0.05. ResultsWe studied 414 newborns, of whom 107 (25.8%) had excessive weight loss. Through the univariate regression, risk factors associated with weight loss>8% were cesarean delivery and older maternal age. At the adjusted multiple regression analysis, the model to explain the weight loss was cesarean delivery (Relative risk 2.27, 95% of Confidence Interval 1.54–3.35). ConclusionsThe independent predictor for weight loss>8% in exclusively breastfed full-term newborns in a Baby-Friendly Hospital was the cesarean delivery. It is possible to reduce the number of cesarean sections to minimize neonatal excessive weight loss and the resulting use of infant formula during the first week of life.

Efficacy of Cleaning and Disinfecting Infant Bottle Feeding by Mothers in Raparin Teaching Hospital at Erbil City/Kurdistan Region

Background: Safe use of infant formula is challenging in developing world settings. Because water and sanitation infrastructure are often suboptimal in these communities, infants who are not breastfed remain at high risk of morbidity and mortality caused by diarrheal pathogens. Objectives: The study aimed to find out the association between methods of cleaning and disinfecting bottle feeding and culture result, determine most sterilize methods by mothers. Methodology: A survey study was carried out at Rapern Teaching hospital in Erbil City Iraq/Kurdistan Region of (15-June-2015 to15-September-2015) .A convenience sample of 40 mothers were selected who used bottle feeding,(10) Mothers of each method ( boiling water, salt (Nacl),Detergent) and tap water only),Then the Then the swape was taken in the screw line of bottle after the cleaning and washing by mother and send to laboratory for culture was taken in the screw line of bottle after the cleaning and washing by mother and send to laboratory for culture. A questionnaire was designed that composed of four parts, (Socio-demographic data of mother and their infant, some questions method of cleaning and disinfecting bottle feeing, the data were analysis by usingFrequency, percentage and Chi square (SPSS, 19 ). Results: The results found (32.5%) of mothers were age (26-30) years old, (37.5%) were illiterate, (45%) of them were at Urban, (82.5%)of infant have history of previous diarrhea (10%) positive culture swap of boiling methods of cleaning and sterilizing the bottle feeding, while (90%) positive pathogen culture swap is seen in detergent method, (100%) was positive culture swap of both methods( tap water and salt). (35%) of bacterial growth was E. Coli, (17.5%) of them was Klepssela. pneumonia, while only (5%) of bacteria were ( Multi bacteria), Regarding the fungi (15%) was positive (Monilia), there is highly significant association between (Culture result, Type of Bacteria, Duration of cleaning and sterilization and Type of bottle) with method of cleaning and sterilization. Conclusions: The study concludes that method of cleaning and sterilization of bottle feeding were sterilize because there are a lot of pathogen were isolated of bottle after cleaning and sterilization by mothers and Boiling method was the most sterilize method and The study indicate that bottle feeding does not provide a safe feeding. Recommendations: The study recommend a guideline and an educational program about method of cleaning and sterilization of bottle feeding for mothers and family must be provide to all maternal and child heath care center in Kurdistan region / Iraq, Encourage mother to use breast feeding and use glass bottle feeding instead of plastic one, because its easer to sterilize and clean. Tap water not recommended for cleaning the bottle feeding because of poor sanitation.

Perda de peso excessiva em recém‐nascidos a termo amamentados exclusivamente ao seio materno em um Hospital Amigo da Criança

ObjectiveTo determine the risk factors for weight loss over 8% in full‐term newborns at postpartum discharge from a Baby Friendly Hospital. MethodsThe cases were selected from a cohort of infants belonging to a previous study. Healthy full‐term newborns with birth weight ≥2.000g, who were exclusively breastfed, and excluding twins and those undergoing phototherapy as well as those discharged after 96 hours of life, were included. The analyzed maternal variables were maternal age, parity, ethnicity, type of delivery, maternal diabetes, gender, gestational age and appropriate weight for age. Adjusted multiple and univariate Cox regression analyses were used, considering as significant p<0.05. ResultsWe studied 414 newborns, of whom 107 (25.8%) had excessive weight loss. Through the univariate regression, risk factors associated with weight loss >8% were caesarean delivery and older maternal age. At the adjusted multiple regression analysis, the model to explain the weight loss was cesarean delivery (relative risk: 2.27 and 95% of confidence interval: 1.54 to 3.35). ConclusionsThe independent predictor for weight loss >8% in exclusively breastfed full‐term newborns in a Baby‐Friendly Hospital was the cesarean delivery. It is possible to reduce the number of cesarean sections to minimize neonatal excessive weight loss and the resulting use of infant formula during the first week of life.

Association of Early Exposure of Probiotics and Islet Autoimmunity in the TEDDY Study.

Probiotics have been hypothesized to affect immunologic responses to environmental exposures by supporting healthy gut microbiota and could therefore theoretically be used to prevent the development of type 1 diabetes mellitus (T1DM)-associated islet autoimmunity. To examine the association between supplemental probiotic use during the first year of life and islet autoimmunity among children at increased genetic risk of T1DM. In this ongoing prospective cohort study that started September 1, 2004, children from 6 clinical centers, 3 in the United States (Colorado, Georgia/Florida, and Washington) and 3 in Europe (Finland, Germany, and Sweden), were followed up for T1DM-related autoantibodies. Blood samples were collected every 3 months between 3 and 48 months of age and every 6 months thereafter to determine persistent islet autoimmunity. Details of infant feeding, including probiotic supplementation and infant formula use, were monitored from birth using questionnaires and diaries. We applied time-to-event analysis to study the association between probiotic use and islet autoimmunity, stratifying by country and adjusting for family history of type 1 diabetes, HLA-DR-DQ genotypes, sex, birth order, mode of delivery, exclusive breastfeeding, birth year, child's antibiotic use, and diarrheal history, as well as maternal age, probiotic use, and smoking. Altogether 8676 infants with an eligible genotype were enrolled in the follow-up study before the age of 4 months. The final sample consisted of 7473 children with the age range of 4 to 10 years (as of October 31, 2014). Early intake of probiotics. Islet autoimmunity revealed by specific islet autoantibodies. Early probiotic supplementation (at the age of 0-27 days) was associated with a decreased risk of islet autoimmunity when compared with probiotic supplementation after 27 days or no probiotic supplementation (hazard ratio [HR], 0.66; 95% CI, 0.46-0.94). The association was accounted for by children with the DR3/4 genotype (HR, 0.40; 95% CI, 0.21-0.74) and was absent among other genotypes (HR, 0.97; 95% CI, 0.62-1.54). Early probiotic supplementation may reduce the risk of islet autoimmunity in children at the highest genetic risk of T1DM. The result needs to be confirmed in further studies before any recommendation of probiotics use is made.

Enzymatic Modification of Anhydrous Milkfat with n‐3 and n‐6 Fatty Acids for Potential Use in Infant Formula: Comparison of Methods

AbstractA structured lipid (SL) with a high amount of sn‐2 palmitic acid was synthesized from anhydrous milkfat and was then enriched with docosahexaenoic (DHA) and arachidonic (ARA) acids using an immobilized lipase. Three different methods were compared including physical blending, enzymatic interesterification, and enzymatic acidolysis. Products were compared with respect to differences in fatty acid profiles, reaction times, antioxidant contents, oxidative stability, melting and crystallization profiles, and reaction yields. The acidolysis method was the least suitable for the synthesis of desired product because of a low reaction yield, low incorporation of DHA, low oxidative stability, and the extra processing steps required. The physical blending and interesterification methods were suitable, but the interesterification product (IE‐SL) had higher amounts of ARA at the sn‐2 position. The IE‐SL contained total ARA and DHA of 0.63 and 0.50 mol%, and 0.55 and 0.46 mol% at the sn‐2 position, respectively. The IE‐SL also contained 44.97 mol% sn‐2 palmitic acid. The reaction yield for the IE‐SL was 91.84 %, and its melting completion and crystallization onset temperatures were 43.1 and 27.1 °C, respectively. This SL might be totally or partially used in commercial fat blends for infant formula.

Thiamine deficiency in tachypnoeic Cambodian infants

Background:Beriberi is endemic in South-east Asia. Diagnosis is based on clinical findings, but correlation of clinical features with blood thiamine concentrations is uncertain.Objectives:To investigate in tachypnoeic Cambodian infants the correlation between whole blood thiamine diphosphate (TDP) concentrations, clinical findings and blood TDP levels after therapy.Methods:Infants hospitalised with tachypnoea were enrolled from October 2011 to January 2012. Initial clinical features, diagnostic test results and final diagnoses were recorded. Blood for TDP determination was collected prior to treatment and at discharge. Matched infants from the general outpatient clinic with minor complaints were enrolled as controls. Thiamine was administered at the discretion of the treating paediatrician.Results:Of the 47 tachypnoeic and 47 control infants, median initial blood TDP concentrations were 83 and 93 nmol/L, respectively (P = 0·69), and were below the estimated limit of normal (<70 nmol/L) in 43% vs 34% (P = 0·40). Median initial TDP levels were 72 and 91 nmol/L in tachypnoeic infants who did or did not receive thiamine, respectively (P = 0·56); at hospital discharge, median TDP concentration had increased by 107 and 3·5 nmol/L in these two subgroups (P<0·001). Classical findings of beriberi such as dysphonia, tachycardia and hepatomegaly did not correlate with low initial TDP concentrations, but infant age, Tiger Balm use, absence of wheezing and low blood CRP levels were associated with low initial TDP levels. Use of infant formula was associated with higher initial TDP levels.Conclusions:Thiamine deficiency is common in tachypnoeic Cambodian infants, but routine clinical assessments do not accurately identify those with low blood TDP concentrations. Parenteral thiamine administration markedly increases TDP levels. Empirical thiamine treatment should be considered for tachypnoeic infants in regions with endemic thiamine deficiency.

Enzymatic Synthesis of Refined Olive Oil-Based Structured Lipid Containing Omega -3 and -6 Fatty Acids for Potential Application in Infant Formula.

Structured lipids (SLs) containing palmitic, docosahexaenoic (DHA), and gamma-linolenic (GLA) acids were produced using refined olive oil, tripalmitin, and ethyl esters of DHA single cell oil and GLA ethyl esters. Immobilized Lipozyme TL IM lipase was used as the biocatalyst. The SLs were characterized for fatty acid profile, triacylglycerol (TAG) molecular species, solid fat content, oxidative stability index, and melting and crystallization profiles and compared to physical blend of substrates, extracted fat from commercial infant formula (IFF), and milk fat. 49.28 mol% of palmitic acid was found at the sn-2 position of SL TAG and total DHA and GLA composition were 0.73 and 5.00 mol%, respectively. The total oleic acid content was 36.13 mol% which was very close to the 30.49% present in commercial IFF. Comparable solid fat content profiles were also found between SLs and IFF. The SLs produced have potential for use in infant formulas.

Food allergy: Two case reports and management challenges in a resource-limited setting

Background. Food allergy has been well described in white children, and cow’s milk protein allergy (CMPA) still remains the most common allergy in these children. Information on the same subject in developing countries is very limited, and management of this condition remains challenging. Case presentation. We report on two cases of children with multiple food allergies. The first patient presented with chronic diarrhoea following the introduction and use of several infant formulas, while the second patient had more severe allergic reactions following ingestion of milk, egg and wheat. Elimination of identified triggers from the diet resulted in significant clinical recovery in both cases. Conclusion. Food allergy, especially CMPA, should be considered more frequently in infants and children from developing countries, especially when there is a significant reaction to the introduction of cow’s milk. A high index of suspicion and appropriate laboratory support are also needed in the diagnosis and management of other food allergies in the African setting.

Fermented infant formulas without live bacteria: a systematic review.

Fermented formulas, i.e., those fermented with lactic acid-producing bacteria during the production process and not containing significant amounts of viable bacteria in the final product, are widely available in many countries. Our aim was to systematically review published evidence related to the safety and health effects of the administration of fermented infant formulas compared with standard infant formulas. The Cochrane Library, MEDLINE, and EMBASE databases and major pediatric conference proceedings were searched. Five randomized controlled trials (RCTs) involving 1326 infants met the inclusion criteria. Compared with standard formula, the use of fermented formula resulted in a similar weight gain and length gain during the study period. Data from one RCT, albeit large, suggest the effectiveness of fermented formula in preventing and treating acute diarrhea. Fermented formula has the potential to reduce some, albeit not well-defined, digestive symptoms. Current evidence does not support the use of fermented formula for preventing cow's milk allergy. Limited available evidence suggests that the use of fermented infant formula, compared with the use of standard infant formula, does not offer clear additional benefits, although some benefit on gastrointestinal symptoms cannot be excluded. What is known • Fermented formulas, i.e., those fermented with lactic acid-producing bacteria during the production process and not containing significant amounts of viable bacteria in the final product, are widely available in many countries. What is new • Limited evidence available suggests that the use of fermented infant formula, compared with the use of standard infant formula, does not offer clear additional benefits, although some benefit on gastrointestinal symptoms cannot be excluded. At the same time, no negative health effects have been documented.

The influence of risk perception on South Korean mothers’ use of infant formula

Given that the choice of breastfeeding is not available to every mother, in spite of its advantages, in this article we examine the factors influencing the use of infant formula in South Korea. We draw on data from a national survey of South Korean mothers conducted in 2009, to show that while maternal use of infant formula feeding was affected by socio-economic factors such as education, income and employment status, it was also influenced by mothers’ perception of risks of infant formula. We found that the way mothers perceived the safety of formula milk’s raw materials was a key factor influencing their decisions about formula feeding, while their perceptions of the safety of the manufacturing facilities and the distribution system was less influential. The mothers in the survey perceived that product safety was more important than considerations such as convenience and economic value of infant formula. We argue that the priority which Korean mothers give to considerations of the risk/safety of infant formula reflects the impacts from a series of food-related incidents, including the 2008 scandal in China where the production of infant milk was contaminated with melamine. Given the socio-economic and perceptual differences between mothers who formula feed and those who breastfeed, we provide guidelines about the ways in which professionals and government agencies can enhance the management and communication of issues relating to the safety of infant formula product.

Preparation of 1, 3‐dioleoyl‐2‐palmitoylglycerol‐rich structured lipids from basa catfish oil: Combination of fractionation and enzymatic acidolysis

1,3‐dioleoyl‐2‐palmitoylglycerol (OPO)‐rich structured lipids were successfully prepared from basa catfish oil by a two‐step process, namely, fractionation to enrich triacylglycerol (TAG) fractions with high content of sn‐2 palmitic acid and Lipozyme RM IM‐catalyzed acidolysis of the fractionated products with free fatty acids from high oleic acid sunflower oil to increase the content of OPO. In the first step, the content of sn‐2 palmitic acid of solid fraction was increased from 49.34 to 60.42% after programmed temperature treatment of basa catfish oil at 60°C for 30 min followed by 30°C for 12 h. In the second step, the solid fraction was used for transesterification with the fatty acids from high oleic acid sunflower oil and the conditions selected for acidolysis reactions were as follows: substrate molar ratio, 1:6 (fatty acids/solid fat); enzyme load, 12 wt%; reaction temperature, 50°C; and reaction time, 2 h. Under these conditions, the contents of sn‐2 plamitic acid and sn‐1, 3 oleic acid were 57.80 and 79.21%, respectively, and the content of POO was increased from 20.13% in the basa catfish oil to 43.80% in the enzymatic product, which indicated high content of OPO.Practical applications: Basa catfish oil is a type of newly discovered oil occurring in nature with similar fatty acid composition and distribution to human milk fat. Preparation of OPO‐rich structured lipids from basa catfish oil is a new method which is important for development of human milk fat substitutes. This process for OPO‐rich structured lipid preparation practically developed by combination of dry fractionation and enzymatic acidolysis has great potential for use in infant formula industry.Basa catfish oil was found to have similar triacylglycerol (TAG) structure to that of human milk fat. The oil was used to produce OPO‐rich structured lipids via a two‐step approach. The first step is to enrich TAG fractions with palmitic acid (PA) at sn‐2 position by low‐temperature fractionation, and the second step is to incorporate more oleic acid (OA) in sn‐1, 3 positions of triacylglycerols by Lipozyme RM IM‐catalyzed acidolysis. The final product had 22.29% total PA, 58.43% PA at sn‐2 position, 80.16% OA at sn‐1, 3 positions, and the content of POO was 43.80%, which indicated high content of OPO.

Economic value of atopic dermatitis prevention via infant formula use in high-risk Malaysian infants.

BackgroundBreastfeeding is best for infants and the World Health Organization recommends exclusive breastfeeding for at least the first 6 months of life. For those who are unable to be breastfed, previous studies demonstrate that feeding high-risk infants with hydrolyzed formulas instead of cow's milk formula (CMF) may decrease the risk of atopic dermatitis (AD).ObjectiveTo estimate the economic impact of feeding high-risk, not exclusively breastfed, urban Malaysian infants with partiallyhydrolyzed whey-based formula (PHF-W) instead of CMF for the first 17 weeks of life as an AD risk reduction strategy.MethodsA cohort Markov model simulated the AD incidence and burden from birth to age 6 years in the target population fed with PHF-W vs. CMF. The model integrated published clinical and epidemiologic data, local cost data, and expert opinion. Modeled outcomes included AD-risk reduction, time spent post AD diagnosis, days without AD flare, quality-adjusted life years (QALYs), and costs (direct and indirect). Outcomes were discounted at 3% per year. Costs are expressed in Malaysian Ringgit (MYR; MYR 1,000 = United States dollar [US $]316.50).ResultsFeeding a high-risk infant PHF-W vs. CMF resulted in a 14% point reduction in AD risk (95% confidence interval [CI], 3%-23%), a 0.69-year (95% CI, 0.25-1.10) reduction in time spent post-AD diagnosis, additional 38 (95% CI, 2-94) days without AD flare, and an undiscounted gain of 0.041 (95% CI, 0.007-0.103) QALYs. The discounted AD-related 6-year cost estimates when feeding a high-risk infant with PHF-W were MYR 1,758 (US $556) (95% CI, MYR 917-3,033) and with CMF MYR 2,871 (US $909) (95% CI, MYR 1,697-4,278), resulting in a per-child net saving of MYR 1,113 (US $352) (95% CI, MYR 317-1,884) favoring PHF-W.ConclusionUsing PHF-W instead of CMF in this population is expected to result in AD-related costs savings.

Infant formula crisis in china: a cohort study in sichuan province.

China has become the largest market of infant formula in the world. The consumption of infant formula is widespread across the country. This study investigated the opinions of Chinese mothers on infant formula. A prospective cohort study (n=695) was undertaken in 2011 in Sichuan province of China two years after the melamine scandal. Infant-feeding practices and mothers' opinions on infant formula-use were documented in detail. A total of 674 mothers (97%) had initiated breastfeeding by discharge. Of the 21 mothers who did not commence breastfeeding, 13 made a decision to exclusively feed their babies with infant formula because of hepatitis B virus infection. Nearly 70% of newborns received infant formula as their first feed, and the prevalence increased to 88% within one month. Having insufficient breastmilk was perceived by the majority (77%) of mothers as the reason behind infant formula feeding. About half (46%) of the mothers agreed with or were ambivalent that infant formula feeding does not reduce their breastmilk production. More than one-third (38%) of women thought that formulafed infants sleep longer at night than those who are breastfed. In addition, this perception was positively associated with the use of formula within one month postpartum (p=0.003). In conclusion, mothers' opinions appear to influence the use of infant formula in China. There is a need for further education on breastfeeding and infant-feeding options to maintain and improve breastfeeding outcomes in China.