Non-human Milk Research Articles

Registered nurses' knowledge and practice of preoperative fasting and medication administration.

Knowledge of fasting or Nil Per Os (NPO) guidelines is an essential component of nursing care in the preoperative period. To describe registered nurses' (RNs) knowledge and management of the preoperative NPO period. Selected surgical wards in a tertiary hospital in the Western Cape, South Africa. Quantitative descriptive, cross-sectional study utilising a structured questionnaire. The population consisted of RNs working in selected surgical wards. Convenience sampling was used and adequate knowledge was determined as ≥ 90%. The response rate was 100%. Of the 68 participants, 48 (70.6%) held a diploma and 20 (29.4%) held a degree as the highest academic qualification achieved. Sixty-one (89.7%) participants knew the correct reason for keeping patients NPO. Sixty-five (95.6%) knew the correct answer for the NPO time for solids while only 27 (39.7%) knew the correct answer for clear fluids. Only 30 (44.1%), 26 (38.2%) and 33 (48.5%) participants, respectively, answered the questions about oral analgesia, oral antibiotics and chronic medication administration during the NPO period correctly. Significantly more degree participants knew the correct answer for the fasting time for non-human milk (p = 0.005) and more diploma participants would administer chronic medication during the NPO period (p = 0.037). Inadequate knowledge of NPO times for various fluids and unsatisfactory practice of medication administration for oral and chronic medication require attention. This study highlights the importance that ongoing education is needed to ensure that patients receive the most up-to-date evidence-based care during the NPO period.

Potential for Misclassification of Infants' Usual Feeding Practices using 24-Hour Dietary Assessment Methods

Feeding patterns of 131 low income Peruvian infants were assessed by 1574 single-day studies (12-h observations plus 12-h recall) of dietary intake and by mothers' monthly reports of usual feeding practices to determine whether feeding pattern classification depends on the assessment method used. Results suggest that single-day studies produce a different view of feeding practices than do mothers' reports of usual behavior. Exclusive breast-feeding in infants younger than 4 mo was observed 25% more often than reported. Non-human milk consumption was reported 30% more often than observed. Disagreement between reported and observed practices was related by logistic regression analyses to mother's age and education, number of children younger than 5 y in the home and infant age and illness on the observation day. Most disagreement between reported and observed behavior could have been due to daily variation in feeding practices. Consumption during the past 24 h should not be used alone as the basis for classifying infant feeding practices in survey research.

Breastfeeding Increases the Expression of TLR4, TNF-α, CCL2, and CCL3 in the Prepuce Tissue of Neonates

Innate immunity plays a significant role in the tissue repair process. It is well documented that breastfeeding may alter immune responses. Thus, this study was designed to evaluate the effects of breastfeeding on the levels of TLR1-4, TNF-α, TGF-β, CCL2, and CCL3 in the prepuce tissue of neonates. This study was conducted on 90 samples of prepuce tissue obtained from neonates (45 neonates who were breastfed with human milk [HM] and 45 neonates who were not breastfed and received non-human milk [NHM]). The tissues were homogenized and mRNA levels of TLR1-4 and protein levels of TNF-α, TGF-β, CCL2, and CCL3 were analyzed using Real-Time PCR and ELISA techniques, respectively. Protein levels of TNF-α, CCL2 and CCL3, and mRNA levels of TLR4 were significantly lower in the NHM neonates than in the HM neonates. There was a significant negative correlation between duration of pregnancy and mRNA levels of TLR1 in the NHM neonates. These results indicate that breastfeeding may be associated with the regulated expression of TLR4 and its related cytokines/chemokines and that it may improve wound healing and aid in the fight against pathogens.

Assessment Of Knowledge Regarding Weaning Practices Among Mothers of Gulab Devi Educational Complex

Breastfeeding is the process of feeding human milk to a newborn as well as some other type of formula milk or liquid or nonhuman milk. After 6 months, solid foods are introduced to the baby, known as weaning. Objective: To assess the knowledge of the mothers towards weaning practices of children up to 2 years of age. Methods: A cross-sectional study was carried out at the Gulab Devi educational complex in Lahore. A sample of 100 respondents was taken from February 2022 to March 2022. Research questionnaires were used as a tool for data collection. Results: The mean age of weaning mothers ranges from 30-45, having 2-3 children. Most mothers from middle-class families living in the joint family system are postgraduate with no medical history. According to the results, 90% of mothers already had the knowledge. 56% of mothers introduce solid foods after the age of 6 months. 72% of mothers introduced rice and cereals as the first solid food to their babies. 74% of mothers think cow milk is not good for an infant at 1st milk. 72% of mothers had knowledge about weaning start time. 54% of the knowledge about weaning mothers learns from their grandparents. Conclusions: Weaning is the fundamental element of the child and is important for health and development. So it is important that the mother should have knowledge about weaning, its start time and solid foods for weaning. The main outcome of the study was that most of the mothers of infants had knowledge regarding weaning diets

Neonatal Birthweight, Infant Feeding, and Childhood Metabolic Markers.

Antenatal and early neonatal nutritional environment may influence later metabolic health. Infants of mothers with gestational diabetes mellitus (GDM) have higher risk for childhood obesity and metabolic syndrome (MetS). Leptin and adiponectin are known biomarkers for MetS and may guide interventions to reduce later obesity. We sought to examine the relationship between birthweight, early infancy feeding practices, and biomarkers for MetS in offspring of women with mild GDM. Secondary analysis of a prospective observational follow-up study on the offspring of women who participated in a multicenter randomized treatment trial on mild GDM. Children were evaluated by research coordinators and biospecimens collected at the age of 5 to 10. Plasma concentrations of leptin and adiponectin were compared between large for gestational age (LGA) and average birthweight (AGA) infants, and according to whether solid foods were introduced early (<6 months of age) or at the recommended age (≥6 months of age). Multivariable analysis adjusted for fetal sex, race/ethnicity, and maternal body mass index. Leptin and adiponectin were measured in 336 plasma samples. In bivariate analysis, compared with AGA children, LGA children had lower leptin (5.0 ng/mL [3.6-6.0] vs. 5.8 ng/mL [4.5 = 6.6], p = 0.01) and similar adiponectin (6.3 µg/mL [5.1-7.9] vs. 6.4 µg/mL [5.3-8.6], p = 0.49) concentrations. Maternal/child characteristics were similar between the early/delayed solid feeding groups. Leptin and adiponectin concentrations were similar in the early fed and delayed feeding groups (5.8 ng/mL [4.6-6.7] vs. 5.6 ng/mL [4.2-6.6], p = 0.50 and 6.4 µg/mL [5.4-8.1] vs. 6.4 µg/mL [5.1-8.8], p = 0.85, respectively). After controlling for covariates, children who were LGA and AGA at birth had similar leptin concentrations. Birthweight and early infancy feeding practice are not associated with alterations in leptin and adiponectin in children of women with mild GDM. · Adipocytokines are markers of metabolic status.. · Children of women with mild GDM may be at risk for MetS.. · Biomarkers similar in LGA and AGA groups.. · Biomarkers similar in early and delayed solid-fed groups.. · Nonhuman milk does not modify effect of feeding practice..

Extracellular Vesicles in Human Milk.

Milk supports the growth and development of infants. An increasing number of mostly recent studies have demonstrated that milk contains a hitherto undescribed component called extracellular vesicles (EVs). This presents questions regarding why milk contains EVs and what their function is. Recently, we showed that EVs in human milk expose tissue factor, the protein that triggers coagulation or blood clotting, and that milk-derived EVs promote coagulation. Because bovine milk, which also contains EVs, completely lacks this coagulant activity, important differences are present in the biological functions of human milk-derived EVs between species. In this review, we will summarize the current knowledge regarding the presence and biochemical composition of milk EVs, their function(s) and potential clinical applications such as in probiotics, and the unique problems that milk EVs encounter in vivo, including survival of the gastrointestinal conditions encountered in the newborn. The main focus of this review will be human milk-derived EVs, but when available, we will also include information regarding non-human milk for comparison.

Human Milk Oligosaccharide (HMO) Metabolizing Gene Abundances in Human Infant Fecal Samples

ObjectivesTo benefit from the complex oligosaccharides found in human milk, an infant relies on microbial metabolism of these compounds. The main objective of this study was to determine the abundance of Bifidobacterium infantis human milk oligosaccharide (HMO) metabolizing genes in infant fecal samples. MethodsFecal samples from 40 6-mos-old infants were collected. Genomic DNA was extracted, and quantitative real-time PCR was used to determine the abundance of several genes in B. infantis. B infantis specific primer sets were used to target 5 HMO metabolizing genes as well as the 16S rRNA gene. Additional 16S rRNA primer sets were used to target overall bacteria, overall Bifidobacterium, B. breve and B. longum. Abundances of each qPCR reaction were compared by infant human milk exposure, solid food intake, and mode of delivery. ResultsMode of delivery was not associated with any PCR targets. Two HMO genes, a sialidase and a glycoside hydrolase, as well as a B. infantis 16S rRNA gene were more abundant in the feces of human milk fed infants (p < 0.05). The sialidase and a B. infantis 16S rRNA gene tended to be less abundant when a larger percentage of an infant’s diet consisted of solids (p < 0.10). When accounting for solid food intake, human milk exposure continued to be positively associated with the sialidase and a B. infantis 16S rRNA gene abundance (p < 0.05) and tended to be related to the abundance of the glycoside hydrolase (p < 0.10). An assessment of 5 B. infantis specific primer sets targeting HMO metabolizing genes demonstrated that the stools of human milk fed infants harbored a more diverse set of these genes than those of non-human milk fed infants (p = 0.02). ConclusionsHerein, we have identified a qPCR primer set targeting a sialidase that is consistently associated with human milk exposure even in the presence of solid food intake. With further development and validation in additional populations of infants, these assays could be used to group samples by dietary exposure even where no record of dietary intake exists. Thus, this assay would provide a method by which infant human milk intake proximal to sample collection can be assessed quickly in any well-equipped molecular biology lab. Funding SourcesThis research was partially supported by the MSU College of Agriculture and Natural Resources Undergraduate Research Program as well as the Max Gonzenbach Research Scholarship.

Consumption of breast milk, formula and other non-human milk by children aged under 2 years: analysis of eighty-six low- and middle-income countries.

To investigate the prevalence and socio-economic inequalities in breast milk, breast milk substitutes (BMS) and other non-human milk consumption, by children under 2 years in low- and middle-income countries (LMIC). We analysed the prevalence of continued breast-feeding at 1 and 2 years and frequency of formula and other non-human milk consumption by age in months. Indicators were estimated through 24-h dietary recall. Absolute and relative wealth indicators were used to describe within- and between-country socio-economic inequalities. Nationally representative surveys from 2010 onwards from eighty-six LMIC. 394 977 children aged under 2 years. Breast-feeding declined sharply as children became older in all LMIC, especially in upper-middle-income countries. BMS consumption peaked at 6 months of age in low/lower-middle-income countries and at around 12 months in upper-middle-income countries. Irrespective of country, BMS consumption was higher in children from wealthier families, and breast-feeding in children from poorer families. Multilevel linear regression analysis showed that BMS consumption was positively associated with absolute income, and breast-feeding negatively associated. Findings for other non-human milk consumption were less straightforward. Unmeasured factors at country level explained a substantial proportion of overall variability in BMS consumption and breast-feeding. Breast-feeding falls sharply as children become older, especially in wealthier families in upper-middle-income countries; this same group also consumes more BMS at any age. Country-level factors play an important role in explaining BMS consumption by all family wealth groups, suggesting that BMS marketing at national level might be partly responsible for the observed differences.

Advances in Neonatal Infections.

Despite continued advances and developments in neonatal medicine, neonatal sepsis is the third leading cause of neonatal mortality and a major public health problem, especially in developing countries. Sepsis accounts for mortality for almost 50% of global children under 5 years of age.Over the past 50 years, there have been many advances in the diagnosis, prevention, and treatment of neonatal infections. The diagnostic advances include better culture techniques that permit more rapid confirmation of the diagnosis, advent of polymerase chain reaction (PCR) to rapidly diagnose viral infections, use of biologic markers indicating evidence of infection, and a better understanding of immunoglobulin markers of infection. From a therapeutic stand point, there have been a variety of antibiotics, antifungals, and antiviral agents, better approaches to prevent sepsis, specific immunotherapy, for example, respiratory syncytial virus (RSV); bundled approach to prevention of deep-line infection and better antibiotic stewardship, leading to earlier discontinuation of antibiotic therapy.Hand hygiene remains the benchmark and gold standard for late-onset sepsis prevention. The challenge has been that each decade, newer resistant bacteria dominate as the cause of sepsis and newer viruses emerge, for example, human immunodeficiency virus, zika virus, and novel coronavirus disease 2019.Future treatment options might include stem cell therapy, other antimicrobial protein and peptides, and targeting of pattern recognition receptors in an effort to prevent and/or treat sepsis in this vulnerable population. Also, the microbiome of premature infants has a smaller proportion of beneficial bacteria and higher numbers of pathogenic bacteria compared with term infants, likely owing to higher frequencies of cesarean sections, antibiotic use, exposure to the hospital environment, and feeding nonhuman milk products. Modifying the microbiome with more mother's milk and shorter duration of antibiotics in noninfected babies should be a goal. KEY POINTS: · Neonatal sepsis remains a leading cause of mortality.. · Challenges include bacterial resistance and newer viruses.. · Future treatments may include newer antibiotics/antivirals and stem cell therapy..

The impact of thermal pasteurization on viral load and detectable live viruses in human milk and other matrices: a rapid review.

Holder pasteurization (62.5°C, 30min) of human milk is thought to reduce the risk of transmitting viruses to an infant. Some viruses may be secreted into milk - others may be contaminants. The effect of thermal pasteurization on viruses in human milk has yet to be rigorously reviewed. The objective of this study is to characterize the effect of common pasteurization techniques on viruses in human milk and non-human milk matrices. Databases (MEDLINE, Embase, Web of Science) were searched from inception to April 20th, 2020, for primary research articles assessing the impact of pasteurization on viral load or detection of live virus. Reviews were excluded, as were studies lacking quantitative measurements or those assessing pasteurization as a component of a larger process. Overall, of 65 131 reports identified, 109 studies were included. Pasteurization of human milk at a minimum temperature of 56-60°C is effective at reducing detectable live virus. In cell culture media or plasma, coronaviruses (e.g., SARS-CoV, SARS-CoV-2, MERS-CoV) are highly susceptible to heating at ≥56°C. Although pasteurization parameters and matrices reported vary, all viruses studied, except parvoviruses, were susceptible to thermal killing. Future research important for the study of novel viruses should standardize pasteurization protocols and should test inactivation in human milk. Novelty In all matrices, including human milk, pasteurization at 62.5°C was generally sufficient to reduce surviving viral load by several logs or to below the limit of detection. Holder pasteurization (62.5°C, 30 min) of human milk should be sufficient to inactivate nonheat resistant viruses, including coronaviruses, if present.

Infant Formula Consumption Is Positively Correlated with Wealth, Within and Between Countries: A Multi-Country Study

ABSTRACTBackgroundIn contrast with the ample literature on within- and between-country inequalities in breastfeeding practices, there are no multi-country analyses of socioeconomic disparities in breastmilk substitute (BMS) consumption in low- and middle-income countries (LMICs).ObjectiveThis study aimed to investigate between- and within-country socioeconomic inequalities in breastfeeding and BMS consumption in LMICs.MethodsWe examined data from the Demographic Health Surveys and Multiple Indicator Cluster Surveys conducted in 90 LMICs since 2010 to calculate Pearson correlation coefficients between infant feeding indicators and per capita gross domestic product (GDP). Within-country inequalities in exclusive breastfeeding, intake of formula or other types of nonhuman milk (cow/goat) were studied for infants aged 0–5 mo, and for continued breastfeeding at ages 12–15 mo through graphical presentation of coverage wealth quintiles.ResultsBetween-country analyses showed that log GDP was inversely correlated with exclusive (r = −0.37, P < 0.001) and continued breastfeeding (r = −0.74, P < 0.0001), and was positively correlated with formula intake (r = 0.70, P < 0.0001). Continued breastfeeding was inversely correlated with formula (r = −0.79, P < 0.0001), and was less strongly correlated with the intake of other types of nonhuman milk (r = −0.40, P < 0.001). Within-country analyses showed that 69 out of 89 did not have significant disparities in exclusive breastfeeding. Continued breastfeeding was significantly higher in children belonging to the poorest 20% of households compared with the wealthiest 20% in 40 countries (by ∼30 percentage points on average), whereas formula feeding was more common in the wealthiest group in 59 countries.ConclusionsBMS intake is positively associated with GDP and negatively associated with continued breastfeeding in LMICs. In most countries, BMS intake is positively associated with family wealth, and will likely become more widespread as countries develop. Urgent action is needed to protect, promote, and support breastfeeding in all income groups and to reduce the intake of BMS, in light of the hazards associated with their use.

Historical Antecedents of Breastfeeding for African American Women: from the Pre-Colonial Period to the Mid-Twentieth Century.

African American women have much lower breastfeeding rates than other racial and ethnic groups in the USA. While researchers are beginning to explore contemporary factors contributing to this inequality, much less research has been devoted to the historical conditions that have contributed to these disparities. The aim of this paper was to describe the social, economic, and political factors that have influenced African American breastfeeding behavior in the USA from the colonial era through the mid-twentieth century. A thematic analysis was conducted across multiple databases and sources. A social history framework, which focuses on the experiences of ordinary people and events, was used to identify and integrate themes found within the reviewed literature. Three themes emerged: (1) Labor forces and other socio-cultural factors affected feeding practices and communal caregiving; (2) history of supplementation; and (3) influence of medicalization of birth and mobility on infant feeding in the twentieth century. These themes illustrate how African American women's ability to breastfeed has been significantly constrained throughout the U.S. Supplementation with non-human milk substitutes and communal caregiving helped African American women navigate infant rearing under adverse socioeconomic circumstances. Social, political, and economic factors have contributed significantly to African American women's ability to breastfeed throughout the U.S. Understanding the influences of historical antecedents on breastfeeding decisions over time may be key to finding effective interventions that might increase breastfeeding rates within this population.

Thirsty work: Exploring children's experiences of preoperative fasting.

Preoperative fasting is performed to reduce aspiration risk during general anesthesia. Recommendations are that patients should fast for 6hours from solids and nonhuman milk, 4hours from breast milk, and 2hours from clear fluids. However, previous studies have shown that children fast far in excess of these times, which can result in perioperative complications and unnecessary discomfort for the child. This prospective, mixed-methods study aims to explore the experiences of pediatric patients undergoing preoperative fasting in Leeds General Infirmary. It also aims to investigate fasting durations of these patients and factors which influence these. Over 2weeks, surveys were distributed to all parents of elective pediatric patients and completed prior to their child being called to theater. Children over the age of six were offered a child survey, which had been specifically developed for the study, with visual Likert scales and an area for free text. The gathering of children's comments about their experience of preoperative fasting is unique to this study. Seventy-one parent surveys and 48 child surveys were completed, with a mean patient age of 8.3years (SD 4.1). The mean preoperative fasting time for food was 11.7hours (SD 4.4) and 6.9hours (SD 5.0) for fluids. Fasting times were far in excess of the minimums recommended, negatively impacting patient experience with 34% reporting being hungry/very hungry and 19% thirsty/very thirsty. Most children's comments suggested that they coped well with the fasting; however, several children reported feelings of sadness and anxiety. Preoperative fasting times in pediatric patients far exceed the durations set by international guidelines. Given that many children reported extreme feelings of hunger and thirst or emotional effects from the fast, these durations need to be optimized in order to improve patient experience.

Breastfeeding is associated with children's dietary diversity in Brazil.

The aim of this study was to describe food consumption patterns in Brazilian children aged 6-24 months and to assess differences between breastfed children who do not consume non-human milks, breastfed children who consume non-human milks, and non-breastfed children. This study used data from the Brazilian National Demographic and Health Survey (2006). The food consumption patterns of 1,455 children were assessed using a food frequency questionnaire. One indicator adopted in this study was the healthy diverse diet. The association between breastfeeding and food consumption was tested using multivariate Poisson regression. At the interview, 15.8% of the children were breastfed without consuming non-human milk, 30.7% consumed breast milk in conjunction with non-human milk, and 53% were not breastfed anymore. Over half consumed the recommended foods, 78% consumed foods rich in sugar, fat, and salt, and only 3.4% were on a healthy diverse diet. The breastfed children who did not consume non-human milks were almost five times more likely to be on a healthy diverse diet and were 19% less likely to consume foods rich in sugar, fat, and salt than the breastfed children who also consumed non-human milks and the non-breastfed children.

Determinants of infant breastfeeding practices in Nepal: a national study

BackgroundOptimal breastfeeding practices, reflected by early initiation and feeding of colostrum, avoidance of prelacteal feeds, and continued exclusivity or predominance of breastfeeding, are critical for assuring proper infant nutrition, growth and development.MethodsWe used data from a nationally representative survey in 21 district sites across the Mountains, Hills and Terai (southern plains) of Nepal in 2013. Determinants of early initiation of breastfeeding, feeding of colostrum, prelacteal feeding and predominant breastfeeding were explored in 1015 infants < 12 months of age. Prelacteal feeds were defined as food/drink other than breast milk given to newborns in first 3 days. Predominant breastfeeding was defined as a child < 6 months of age is mainly breastfed, not fed solid/semi-solid foods, infant formula or non-human milk, in the past 7 days. Adjusted prevalence ratios (APR) and 95% confidence intervals (CI) were estimated, using log Poisson regression models with robust variance for clustering.ResultsThe prevalence of breastfeeding within an hour of birth, colostrum feeding, prelacteal feeding and predominant breastfeeding was 41.8, 83.5, 32.7 and 57.2% respectively. Compared to infants not fed prelacteal feeds, infants given prelacteal feeds were 51% less likely to be breastfed within the first hour of birth (APR 0.49; 95% CI 0.36, 0.66) and 55% less likely to be predominantly breastfed (APR 0.45; 95% CI 0.32, 0.62). Infants reported to have received colostrum were more likely to have begun breastfeeding within an hour of birth (APR 1.26; 95% CI 1.04, 1.54) compared to those who did not receive colostrum. Infants born to mothers ≥ 20 years of age were less likely than adolescent mothers to initiate breastfeeding within 1 hour of birth. Infants in the Terai were 10% less likely to have received colostrum (APR 0.90; 95% CI 0.83, 0.97) and 2.72 times more likely to have received prelacteal feeds (APR 2.72; 95% CI 1.67, 4.45) than those in the Mountains.ConclusionsMost infants in Nepal receive colostrum but less than half initiate breastfeeding within an hour of birth and one-third are fed prelacteal feeds, which may negatively affect breastfeeding and health throughout early infancy.

Capillary electrophoresis of sialylated oligosaccharides in milk from different species

Oligosaccharides are relevant components of human milk, which have been quite well studied for their pre-biotic effect and their capacity in stimulating the immune system. Since oligosaccharides from milk of non-human mammals received so far less attention, the aim of this work was the application of capillary electrophoresis (CE) for the analysis of sialylated oligosaccharides in cow, goat and equine (mare and donkey) milk to possibly identify potential sources of oligosaccharides to use as health promoting ingredients in functional foods. Human milk was used as reference milk. A recent CE technique was applied to resolve and quantify 3-sialyllactose (3-SL), 6-sialyllactose (6-SL) and disialyl-lacto-N-tetraose (DSLNT). Analysis of non-human milk samples confirmed differences among species and individuals: DSLNT, which was the most abundant compound in human milk (455–805μg/mL) was missing in most of the samples. In most cases, 3-SL showed to be the most concentrated of the quantified analytes, with values ranging from 12 to 77μg/mL.

Lactose nutrition in lactase nonpersisters.

Lactose handling by the human gut by most people, beyond being breast-fed, has been considered a disorder rather than physiological. A non-human mammalian milk source is novel for the majority. During the first 6 months of life, when neonates and infants are best breast-fed, lactose along with other macronutrients, provides energy, but may have other functions as well. At birth, babies are endowed with their mother's vaginal microbiome, but not if they are born by Caesarean section. How much maternal milk lactose survives the infant's small intestine and is processed by this unique gut microbiome and to what end is still uncertain, but no lactose or galactose appears in the faeces. Once intestinal lactase activity declines in most infants, lactose may enhance innate immunity through the cathelicidin antimicrobial peptide (CAMP), which is best achieved by lactose synergy with other colonic fermentation metabolites such as butyrate. It is of interest whether this lactose function or a variant of it persists. It might not be evident when lactase is persistent, as it is in most people of northern European ancestry. Population genomics indicate that lactase persistence became prevalent only about 3000-1000 BC, the Bronze Age of Eurasia. Gastrointestinal symptoms (GIS) in lactase nonpersisters who consume dairy foods are partly dose dependent and not usually evident with single lactose intakes≤25 g per day. Spreading intake across the day reduces the risk as can various dietary patterns. Nevertheless, individual differences in GIS lactose sensitivity may merit public health and clinical consideration.

Determinants of liquid gastric emptying: comparisons between milk and isocalorically adjusted clear fluids

Although current preoperative fasting guidelines apply restrictions to drinks containing milk because of delayed gastric emptying, the safe volume of milk that can be consumed up to 2 h before surgery on a theoretical basis has not yet been defined. We aimed to determine whether delayed gastric emptying depended mainly on the total amount of calories irrespective of compositional differences between milk and clear fluids. We prepared five beverages with a uniform volume (500 ml) and step-wise increments in calories (0, 220, and 330 kcal), comprised mainly of non-human milk, pulpless orange juice, water, and gum syrup. The gastric emptying rate of each beverage was determined by ultrasound measurements of the gastric antral cross-sectional area after their ingestion by eight healthy fasting volunteers. The emptying rates of 500 ml of orange juice and 330 ml of non-human milk with 170 ml of water (both were 220 kcal) from the stomach were similar. Furthermore, 450 ml of orange juice with 50 ml of gum syrup and 500 ml of non-human milk (both were 330 kcal) left the stomach at similar rates. The 220 kcal beverages emptied faster than the 330 kcal beverages. There were no significant differences in liquid gastric emptying after drinking equal volumes of either orange juice or milk as long as both had the same amount of calories. Liquid gastric emptying depends chiefly on the total caloric content. UMIN000012537.

Role of Human Milk in the Development of Gastrointestinal Bacterial Flora and Immunity in Preterm Infants

The intestinal microflora plays an important role in the health and well-being of the host. Crucial to this is the provision of a natural defense mechanism against invading pathogens. Intestinal flora contains both friendly and potentially pathogenic organisms. Well-balanced bacterial colonization is an important factor in the development and maintenance of the gut immune system. Among the factors influencing the establishment of the intestinal flora, age, diet, medications, and stress appear to be the leading causes. The intestinal flora of the newborn plays a major role in the development of gut physiology and pathology leading to gut immunology and the ability to fight neonatal infections and other gastrointestinal diseases. Full term infants receive regular human or non-human milk diets orally as their primary nutritional source. This facilitates the normal intestinal colonization process. Preterm infants lack this feeding and therefore are deprived of the host defense mechanisms influenced by gut flora. This review discusses the factors in human milk that contribute to gut physiology, gut microbiology, and intestinal immunity, which lead to the healthy growth of preterm infants.

Effects of Breastfeeding on Weight Loss and Recovery of Pregestational Weight in Adolescent and Adult Mothers

Exclusive breastfeeding (EBF) in adolescent mothers has been associated with greater postpartum maternal weight loss. To assess the associations between EBF and weight loss in adolescent and adult mothers and between EBF and weight and length gain of their children. A cohort of 68 adolescent mothers (15 to 19 years), 64 adult mothers (20 to 29 years), and their infants were studied. Anthropometric measurements were performed at 15, 90, 180, and 365 days postpartum in the mothers and children. EBF was defined as consumption of human milk without supplementation of any type (water, juice, nonhuman milk, or food) for 4 months. Sixty-five percent of mothers sustained EBF for 4 months. There were no significant differences in the weight or length of the infants of adolescent and adult mothers at 365 days postpartum. Among infants of adult mothers, there was a significant difference between the weight gain of those were exclusively breastfed and those who were not exclusively breastfed (6,498 +/- 1,060 vs 6,096 +/- 1,035 g, p < .050) at 365 days postpartum, according to the parameters for weight gain and length established by the World Health Organization (WHO). Among both adult and adolescent mothers, those who practiced EBF lost more weight than those who did not practice EBF (-2.9 kg, 95% interquartile range, -5.7 to 0.8 kg, vs -1.8 kg 95% interquartile range -2.8 to 2.2 kg; p = .004). Gestational weight gain, duration of EBF, and recovery menstruation explained 21% of the variance (F = 28.184, p = .001) in change in postpartum maternal weight (in kilograms) from 0 to 365 days postpartum in all mothers. Pregestational weight, duration of EBF, and maternal age were factors that explained 14% (F = 22.759, p = .001) of the change in the weight and length of the infants from 0 to 365 days of life. EBF in adolescent and adult mothers influences postpartum weight loss and provides adequate infant growth in accordance with the WHO 2006 standards.