Non-human Milk Research Articles

Is traditional fasting policy changing? Results of a Swiss survey on current practice

Is traditional fasting policy changing? Results of a Swiss survey on current practice

HIV disease: Working Group Report of the First World Congress of Pediatric Gastroenterology, Hepatology, and Nutrition.

HIV disease: Working Group Report of the First World Congress of Pediatric Gastroenterology, Hepatology, and Nutrition.

Zinc and breastfed infants: if and when is there a risk of deficiency?

Infancy is a time of relatively high zinc requirements. Human milk provides an excellent source of highly bioavailable zinc and generally meets the needs of the healthy young exclusively breastfed infants for the first several months of life. Investigations of exclusively breastfed infants less than 6 mo of age have generally found zinc homeostasis and status to be adequate, although there are indications that zinc intake from human milk alone may become limiting by around 6 mo of age. Exceptions may be small for gestational age and low birth weight infants, who may well benefit from increased zinc intake before 6 mo of age. The older infant clearly becomes dependent on non-human milk sources of zinc, i.e., from complementary foods. Traditional early complementary foods, such as cereals, fruits, and vegetables provide very modest amounts of zinc, and for those high in phytic acid, bioavailability may be low. Introduction of animal products or zinc supplementation may be important to meet the older infant's zinc requirements This is likely to be particularly important in less protected environments with a high infectious burden and limited dietary options.

Nutritional management of acute diarrhea.

Despite recommendations from several bodies such as the World Health Organization and others that feeding should be continued during diarrhea, the practice of withholding food during the early stages of diarrhea is still widespread. This contributes to a deterioration in patients' nutritional state. The principal controversy in the nutritional therapy of acute gastroenteritis centers on the relative risks of cows'-milk feeds. The two things that need to be considered in determining the optimum approach to feeding the child with acute diarrhea are the optimum timing for feeding children in relation to the onset of and recovery from symptoms and, secondly, the effects of specific food ingredients in the diet. Recent studies have demonstrated that the vast majority of young children with acute diarrhea can be successfully managed with continued feeding of undiluted non-human milk. Routine dilution of milk and routine use of lactose-free formula are not necessary, especially when oral rehydration therapy and early feeding (in addition to milk) form the basic approach to the clinical management of diarrhea in children. Confounding factors are the severity of the diarrhea, coexistent malnutrition, and young age (< 1 y); such infants are much more likely to have complications from early feeding with undiluted milk and some would advocate use of specifically designed lactose-free formula in such children. Children who are fed exclusively with human milk and those who receive solid foods with or without human milk may safely continue to receive their usual diets during diarrhea. Those who are fed exclusively with non-human milk--especially when very young and with severe diarrhea or malnutrition--should be closely observed if they continue to consume milk or they should receive a special formulation (e.g., a cereal-milk mixture or fermented milk product). The use of nutrient-dense mixtures of common foods may be advisable to promote compensatory growth in those who lose weight during illness or because of anorexia or malabsorption.

Infant and young child feeding practices among African pastoralists: the Datoga of Tanzania.

Breast-feeding and weaning practices were observed for a cohort of 81 children under 3 years of age in the context of a longitudinal study of social, ecological and nutritional factors affecting growth in a semi-nomadic population of pastoralists in northern Tanzania (WaDatoga of Mbulu District). The adequacy of indigenous infant and young child feeding practices was assessed in relation to current international recommendations. Objectives were to provide baseline data for future investigations of any changes in young child feeding practices which accompany population shifts towards settlement and non-pastoral modes of subsistence, and to improve understanding of the strengths and limitations of indigenous feeding practices in this type of population. It was found that while breast-feeding was universally initiated, other aspects of young child feeding practices do not meet current international recommendations. Prelacteal feeds are commonly used, supplementary feeding with non-human milks usually occurs before 4 months of age, use of solid foods normally begins later than 6 months, and breast-feeding does not continue until 2 years of age for the majority of children. The data have implications for the design of breast-feeding promotion and improved weaning food interventions among African pastoralists.

Feeding practices and growth among low-income Peruvian infants: a comparison of internationally-recommended definitions.

Data from a longitudinal study of 153 low-income Peruvian infants were used to assess the relationship between internationally-recommended definitions of feeding practices and infants' monthly weight gain and weight status at 12 months. Infants were classified into feeding categories using monthly reported data. Analysis of variance was used to assess the relationship between reported usual feeding practices and growth. Reported breastfeeding practices were compared to observed breastfeeding practices and to weighted breast milk intakes to determine the validity of recommended breastfeeding definitions. Breastfed infants who consumed non-human milks during the first month of life gained less weight during that month (P < 0.002) than exclusively and predominantly breastfed infants. Reported daily nursing frequency was associated with observed nursing frequency and breast milk energy intake (P < 0.05) for infants < 9 months old. Patterns of growth varied according to early diets. Infants who consumed breast milk and non-human milks and those who were fully weaned by 4 months were more likely to be underweight at 12 months than other infants. Infants classified as token breastfeeders ( < or = 3 times/24 hours) from 0 to 120 days had monthly gains that were similar to those of fully weaned infants. Infants feeding definitions should 1) continue to differentiate exclusively breastfed infants from other infants who are almost exclusively or predominantly breastfed; 2) distinguish partially breastfed infants who consume only non-breastfeeding frequency or the % of their total daily energy that comes from breast milk.

Fatal Iatrogenic Iodine Toxicity in a Nine-Week-Old Infant

Povidone-iodine has been used since the 1950s for various labelled uses as a topical antiseptic. The toxicity of an excessive dose in internal use is described in this case report. A 9-week old infant was treated for colic by a pediatric gastroenterologist with loperamide and the elimination of nonhuman milk. Without improvement he was hospitalized and given an enema of 50 mL of povidone-iodine diluted in 250 mL of a bowel irrigant. The enema was promptly expelled and 50 mL of the described solution was given hourly for three doses by nasogastric tube. The infant was found lifeless three hours after the last dose and resuscitation was unsuccessful. Autopsy showed a corroded and necrotic intestinal tract, serous fluid in body cavities, a blood total iodine of 14,600 micrograms/dL, protein-bound iodine of 3,400 micrograms/dL and inorganic iodine of 11,700 micrograms/dL.

The relationship between infants' preceding appetite, illness, and growth performance and mothers' subsequent feeding practice decisions

Data from a longitudinal study of 153 low-income Peruvian infants were used to examine (i) whether infant characteristics such as appetite, illness and past growth performance are related to subsequent changes in their feeding practices (e.g. addition of non-human milks, solid foods, weaning), and (ii) whether this relationship depends on maternal characteristics such as feeding exposure and experience (MFEE). With one exception, infants were breastfed from birth. Feeding practices during the first month of life were related to practices throughout infancy. Most mothers changed their practices once (61%) or twice (34%) from birth to 6 months. Low weight gains from 1 to 2 ( P < 0.003) and 2 to 3 ( P < 0.04) months were identified as significant predictors of feeding changes during the following months, using logistic regression models that also adjusted for MFEE, infant gender, previous practice, and previous practice change. The interaction between past weight gain and MFEE (objective ii) was not statistically significant in the logistic regression models. However, when analyzed separately, the relationships between low weight gains and subsequent feeding changes were observed for high but not low MFEE mothers. The prevalences of anorexia and infection (diarrhea, respiratory, and/or fever), and poor length gain during the previous month were not related to subsequent changes in feeding practices. These results suggest that poor growth influences feeding practices from 2 to 4 months, when exclusive breastfeeding is recommended.

Dietary Management of Acute Diarrheal Disease: Contemporary Scientific Issues ,

Contemporary issues in the dietary management of children with acute diarrhea include the optimal timing of introduction of foods during illness, the appropriate use of milk-containing treatment regimens and mixed diets containing common staple foods, and the proper use of specific micronutrient supplements. Results of recent clinical trials indicate that children should be fed continuously during illness with their usual diets. Most young children fed exclusively with non-human milks can continue to consume these products. However, the subgroup of patients with more severe diarrhea and dehydration may have a slightly increased rate of complications and would, therefore, benefit from close supervision or a modification of their diet. Breastfed infants should continue to nurse at the breast during diarrhea. Treatment of anorexia consists of correction of the underlying metabolic derangements and antimicrobial therapy when indicated. Despite the previous focus of dietary management during diarrhea, attention to convalescent feeding is also necessary to assure complete nutritional recovery following illness.

Indicators for monitoring the growth of peruvian infants: weight and length gain vs attained weight and length.

To determine appropriate indicators and age intervals for growth monitoring in this population, the relationship between monthly weight and length indicators and nutritional status at 12 months was evaluated among 102 low-income Peruvian infants. Cutoffs for defining adequate vs slow growth were obtained from published reference data, and sensitivities and specificities of each indicator were calculated. Low weight gain in early infancy, especially from 1 to 2 months, is useful for predicting low weight at 1 year (sensitivity = 81%, specificity = 65%, 25th percentile cutoff). Use of actual weight at 2 months, however, produces comparable results (sensitivity = 86%, specificity = 57%, 50th percentile cutoff). Monthly length gains were weak predictors of low length for age. Neither weight nor length gains accurately predicted the opposite form of undernutrition. Nonhuman milk consumption before 4 months and poor appetite from 3 to 12 months were related to low early weight gain and subsequent undernutrition. Growth monitoring programs in this population should enroll infants at birth, monitor actual weight, promote exclusive breast-feeding and delayed introduction of nonhuman milk, and provide specific feeding advice to mothers of infants with frequently depressed appetite.

Use of Nonhuman Milks in the Dietary Management of Young Children With Acute Diarrhea: A Meta-Analysis of Clinical Trials

To assess the effects of continued feeding of nonhuman milks or formulas to young children during acute diarrhea on their treatment failure rates, stool frequency and amount, diarrheal duration, and change in body weight. A total of 29 randomized clinical trials of 2215 patients were identified by computerized bibliographic search and review of published articles. Data were abstracted and analyzed using standard meta-analytic procedures. Among studies that compared lactose-containing milk or formula diets with lactose-free regimens, those children who received the lactose-containing diets during acute diarrhea were twice as likely to have a treatment failure as those who received a lactose-free diet (22% vs 12%, respectively; P < .001). However, the excess treatment failure rates occurred only in those studies that included patients whose initial degree of dehydration, as reported by authors, was severe, or that were conducted before 1985, when appropriate diarrhea treatment protocols were first widely accepted. Among studies of patients with mild diarrhea, all but one of which were completed after 1985, the overall treatment failure rates in the lactose groups were similar to the rates in the lactose-free groups (13% vs 15%). These results suggest that children with mild or no dehydration and those who are managed according to appropriate treatment protocols, such as that promoted by the World Health Organization, can be treated as successfully with lactose-containing diets as with lactose-free ones. The pooled information from studies that compared undiluted lactose-containing milks with the same milks offered at reduced concentration concluded that (1) children who received undiluted milks were marginally more likely to experience treatment failure than those who received diluted milk (16% vs 12%, P = .05), (2) the differences in stool output were small and of limited clinical importance, and (3) children who received the undiluted milk diets gained 0.25 SD more weight than those who received the diluted ones (P = .004). In addition, as with the previous set of studies, there were no differences in the pooled treatment failure rates between the respective groups in those studies of mildly dehydrated patients conducted after 1985 (14% vs 12%). The vast majority of young children with acute diarrhea can be successfully managed with continued feeding of undiluted nonhuman milks. Routine dilution of milk and routine use of lactose-free milk formula are therefore not necessary, especially when oral rehydration therapy and early feeding (in addition to milk) form the basic approach to the clinical management of diarrhea in infants and children.

Effect of milk-containing diets on the severity and duration of childhood diarrhea.

Individual components of milk from humans and other mammalian species may influence the severity, duration, and nutritional outcome of childhood diarrhea in different ways. Nonetheless, empirical data from clinical trials can be used to assess children's responses to specific milk-containing diets. Factors modifying the response to milk include its source, amount, frequency of feeding, type of processing, and accompanying foods, as well as the type and severity of enteric infection and specific characteristics of the host. Whereas breast-fed infants have less severe diarrhea when breast milk is continued rather than interrupted, infants and children fed with non-human milks tend to have more severe illness than those receiving milk-free or lactose-limited formulas or milk-cereal mixtures. Fermentation of milk may reduce the severity of lactose malabsorption, but additional information regarding the efficacy of yogurt in acute, childhood diarrhea is still needed.

Dietary management of acute childhood diarrhea: Optimal timing of feeding and appropriate use of milks and mixed diets

Several recent clinical trials have examined the optimal timing of feeding and the appropriate foods for use in the dietary management of acute childhood diarrhea. Important methodologic issues relevant to these trials, such as the composition and masking of study diets, measurement of outcome variables, and assessment of nutritional status, are discussed. Available data suggest that feeding should be continued during diarrhea, although a small subgroup of patients receiving nonhuman milk exclusively may have an excess rate of complications. These children should be closely supervised or provided with alternative diets. By contrast, children receiving human milk, nonmilk formulas, and mixed diets are generally able to tolerate these foods and to benefit nutritionally from continued feeding.

Staphylococcal food poisoning from sheep milk cheese.

Cheese made from sheep milk was implicated in food-poisoning incidents in December 1984 and January 1985. Bacteriological examination of batches of cheese failed to reveal a viable pathogen but enterotoxin A produced by Staphylococcus aureus was present. This was the first time that enterotoxin was detected in a food produced in the UK which was associated with poisoning and from which viable Staph. aureus could not be isolated. Subsequent detailed examination of milk, yoghurt and cheese from the same producer revealed that contamination with Staph. aureus was associated with post-infection carriage as well as clinical illness in ewes on the farm. Strains producing enterotoxon. A were still intermittently present in the bulk milk used for cheese production nearly 2 years afterwards, apparently in the absence of clinical illness in the sheep. The possible effects of heat treatment are discussed. Any changes in legislation should cover all non-human mammalian milk used for human consumption.

Clinical and Nutritional Consequences of Lactose Feeding During Persistent Postenteritis Diarrhea

In a double-blind prospective trial, 64 children, 3 to 36 months of age, who had diarrhea for at least 14 days were randomly assigned to receive either a milk-based diet containing 6 g/kg of body weight per day of lactose or the same diet in which the lactose was greater than 95% prehydrolyzed with beta-galactosidase. Clinical and nutritional outcomes were compared. The groups were similar at the start of the study. Four of 33 patients (12.1%) in the lactose group were considered to have treatment failure because of excessive purging with or without refusal to accept the diet, compared with 1 of 31 patients (3.2%) in the hydrolyzed lactose group (P = .20). Among successfully treated boys, fecal excretion was initially similar, but on days 3 to 5 of the trial the lactose group purged a mean 74.4 g/kg per day (95% confidence limits 17.8, 131.0) compared with 42.0 g/kg per day (95% confidence limits 11.4, 72.6) in the hydrolyzed lactose group (P less than .01). Diarrhea stopped within 30 hours of hospital admission in 11 children in the hydrolyzed lactose group (35.5%) compared with 1 child in the lactose group (3.3%) (P less than .001). Fecal excretion of carbohydrate, nitrogen, and energy was significantly greater in lactose group (P less than .01), but there were no significant differences in fat excretion or in incremental weight change during hospitalization. Feeding lactose-containing nonhuman milk as the sole nutrient source to children with persistent diarrhea resulted in substantially greater purging which was sufficiently severe to increase the risk of dehydration in these children.

INFANT FEEDING AND CHILDHOOD CANCER

A case-control study was used to assess whether inadequate exposure to the immunological benefits of human milk may affect infants' response to infection and make them more susceptible to childhood malignancies. 201 Denver children with cancer diagnosed at 1·5-15 years of age were compared with 181 controls, who were selected to be similar to cases for age, sex, and area of residence. Infant feeding categories were: breast feeding (BF) >6 months; BF 6 months; and artificial feeding (AF, or exclusive non-human milk feeding). Compared with BF >6 months, a raised risk for total cancers was found in both BF 6 month and AF groups. This increased risk was largely due to an increased incidence of lymphoma (n = 26).

Do breast-feeding and delayed introduction of solid foods protect against subsequent atopic eczema?

Previous studies relating infant feeding to subsequent atopic eczema have had methodologic flaws that include insensitive study designs, nonblind observation, and failure to control for confounding variables. To avoid these flaws, we conducted a case-control study of 636 patients attending a dermatology clinic. The dermatologic problem in each patient was classified as atopic eczema (case), dermatologic condition unrelated to atopy (control), or dermatologic condition with questionable relation to atopy (uncertain). The feeding history was ascertained later, along with family history and demographic data, by an assistant blind both to the question under study and to the case vs control status of each subject. Breast-feeding was not associated with any reduction in the estimated relative risk of developing atopic eczema. No significant relationship was found among the cases between severity of disease and breast-feeding nor between age of onset of disease and duration of breast-feeding or age at introduction of solid foods. Even when breast-feeding was redefined as "pure" and exclusive (no nonhuman milk or solids) for greater than or equal to 2 months, no protective effect was uncovered. We conclude that breast-feeding and delayed introduction of solids do not protect against atopic eczema, and that previous claims of protective effects were based on data probably biased by nonblinding and important confounders.

Adverse effects of milk formula ingestion on the gastrointestinal tract: An update

The large-scale use of cow's milk in infant feeding is less than one hundred years old. Much progress has been made by the manufacturers of proprietary formulas during this period to make their products safer. Although the current formulas provide an excellent “substitute” for the majority of infants, problems still remain, and it is necessary for every pediatrician and gastroenterologist to be aware of these. The purposes of this article are to review the adverse effects of nonhuman milk on the gastrointestinal tract, to examine the underlying mechanisms, and hopefully to stimulate further thought and research. Particular emphasis will be placed on hypersensitivity reactions, because there now appears to be a swing back to this diagnosis as a result of more sophisticated immunologic investigations. The arguments in favor of breast-feeding, the systemic biochemical differences resulting from different formulas, and the indications for specialized formula feeding are all beyond the scope of this review.