Peruvian Infants Research Articles

Helicobacter pylori Infection in Infants and Toddlers in South America: Concordance between [ 13 C]Urea Breath Test and Monoclonal H. pylori Stool Antigen Test

Accurate noninvasive tests for diagnosing Helicobacter pylori infection in very young children are strongly required. We investigated the agreement between the [(13)C]urea breath test ([(13)C]UBT) and a monoclonal ELISA (HpSA) for detection of H. pylori antigen in stool. From October 2007 to July 2011, we enrolled 414 infants (123 from Brazil and 291 from Peru) of ages 6 to 30 months. Breath and stool samples were obtained at intervals of at least 3 months from Brazilian (n = 415) and Peruvian (n = 908) infants. [(13)C]UBT and stool test results concurred with each other in 1,255 (94.86%) cases (kappa coefficient = 0.90; 95% confidence interval [CI] = 0.87 to 0.92). In the H. pylori-positive group, delta-over-baseline (DOB) and optical density (OD) values were positively correlated (r = 0.62; P < 0.001). The positivity of the tests was higher (P < 0.001; odds ratio [OR] = 6.01; 95% CI = 4.50 to 8.04) in Peru (546/878; 62.2%) than in Brazil (81/377; 21.5%) and increased with increasing age in Brazil (P = 0.02), whereas in Peru it decreased with increasing age (P < 0.001). The disagreement between the test results was associated with birth in Brazil and female gender but not with age and diarrhea. Our results suggest that both [(13)C]UBT and the stool monoclonal test are reliable for diagnosing H. pylori infection in very young children, which will facilitate robust epidemiological studies in infants and toddlers.

Early growth velocities and weight gain plasticity improve linear growth inPeruvian infants

Growth velocity patterns have the potential to signal unhealthy responses to environmental insults with long-term consequences. We aimed to investigate velocities in Peruvian infants (n = 259) in relation to attained anthropometric outcomes at 12 months and to identify determinants of velocities during critical periods of infancy. From 1995 to 1997, a randomised controlled trial of maternal zinc supplementation was conducted in a peri-urban slum area of Lima. Infants were followed monthly through 1 year on a range of anthropometric measures. Three types of velocity variables were studied: (1) incremental velocity (1 months and 3 months); (2) proportional changes (% of total size gained/month); and (3) individual velocity variability [standard deviation (SD) of individual child incremental velocities]. Mean individual child SD of weight velocity was 417 g (±126). In multivariate ordinary least squares regression analyses, growth velocities in month 1 and individual weight velocity variability positively predicted attained length and weight by 12 months. Panel regression by generalised least-squares with random effects of length and weight velocities confirmed the exponentially decelerating pace of growth through infancy and the importance of birth size in driving this trajectory. This study contributes evidence to support the importance of early growth velocities and greater degrees of weight gain plasticity for attained length and weight.

A Hospital Policy Change Toward Delayed Cord Clamping is Effective in Improving Hemoglobin Levels and Anemia Status of 8-month-old Peruvian Infants

To assess the effectiveness of a hospital policy change toward delayed cord clamping on infant hemoglobin (Hb) levels and anemia status at 4 and 8 months of age. A cohort of Peruvian mothers and infants, originating from a pre/post study investigating a change in hospital policy from early to delayed cord clamping, was followed until 8 months postpartum. Infant hemoglobin levels and anemia status were measured at 4 and 8 months postpartum. Following the hospital policy change, adjusted mean infant Hb levels improved by 0.89 gdl(-1) [95% confidence interval (95% CI) 0.57-1.22] and anemia was significantly reduced (aOR = 0.38; 95% CI 0.19-0.78) at 8 months postpartum. A hospital policy change toward delayed cord clamping is effective in improving Hb levels and the anemia status of 8-month-old infants. Prior to scaling-up this intervention, issues related to training, monitoring, safety, additional long-term benefits and specific local conditions should be investigated.

Early and more variable growth velocities improved linear growth in Peruvian infants

This study aimed to investigate: growth velocity patterns in Peruvian infants; determinants of velocities during critical periods; and anthropometric outcomes at 12 mo predicted by velocities. From 1995–1997, an RCT of maternal zinc supplementation was conducted in a periurban slum area of Lima. 579 infants were followed monthly through 12 mo on a range of anthropometric measures. We examined 3 types of velocity variables: incremental velocity (1 mo, 2 mo, and 6 mo); 2) proportional changes (% of total size gained/mo); and 3) individual velocity variability (SD of child incremental velocities). Mean within‐child SD of weight velocity was 0.42 kg (±0.12). Growth velocities in month 1 and variable weight velocity positively predicted attained height and weight by 12 mo in multivariate regression analyses. Panel regression by generalized least‐squared of height and weight velocities confirmed the exponentially decelerating pace of growth through infancy and the importance of birth size in driving this trajectory. Arm fat area was a significant determinant of length gain in the same month. Boys grew more rapidly than girls in the first half of infancy, but not in proportion to the total incremental gain. This study contributes evidence to support the importance of early growth velocities and greater degrees of weight gain plasticity for attained height and weight. The study was funded by USAID and NIH.

Iron Absorption in Peruvian Breast‐fed Infants at Two and Five Months of Age

The effects of maternal prenatal iron (Fe) supplementation on early Fe homeostasis in breast‐fed infants remains largely unexplored. Towards this aim, longitudinal Fe absorption (58Fe) studies were conducted in 41 breast‐fed Peruvian infants at 2 months and 5 months of age. Hodges‐Lehmann 95% CIs were used to express the effect size of Fe supplementation on differences between groups. Predictors of Fe absorption and changes over time were examined using multiple linear regression. Fe absorption from breast milk averaged 7.9% (SD: 9.5) and 12.6% (SD: 11.9) at 2 and 5 months of age. Infants born to Fe supplemented women had greater length at 2 months (p=0.01). Infants born to non‐Fe supplemented women had higher increases in hemoglobin (p&lt;0.05) and Fe absorption (p&lt;0.01), between two and five months of age. Maternal serum zinc and TIBC and infant sTfr levels were associated with significantly increased Fe absorption at 5 months (p&lt;0.05). In analyses of changes in Fe absorption, infant hematocrit (p=0.01) and change in serum Fe (p=0.03) were significant predictors. Fe absorption in early infancy was associated with infant sTfr, hematocrit, and serum iron, and inversely associated with maternal Fe supplementation during pregnancy. Funded by The Nestle Foundation.

Immunogenicity and Safety of a Fully Liquid DTaP-IPV-Hep B-PRP-T Vaccine at 2-4-6 Months of Age in Peru

Objectives: To assess the immunogenicity and safety of a new candidate, fully liquid, hexavalent DTaP-IPVHep B-PRP-T vaccine (Hexaxim™, an AcXim family vaccine) compared to a licensed hexavalent DTaP-IPV-Hep B// PRP-T vaccine (Infanrix hexa®) in Peru. Methods: Infants born to HBsAg seronegative mothers and who had not received a hepatitis B vaccine prior to entry into the study were randomized to receive either Hexaxim™ (Group 1) or Infanrix hexa® (Group 2) at 2, 4, 6 months of age. Seroprotection (SP) rate for hepatitis B (anti-Hep B antibody concentration ≥10 mIU/mL) was analysed for non-inferiority (Group 1 minus Group 2) 1 month post-primary series. Anti-diphtheria and anti-polyribosyribitol phosphate (PRP) antibody responses were analysed descriptively. Safety was analysed from parental reports. Results: Seroprotection rate for anti-Hep B antibody titers ≥10 mIU/mL was high in both groups (≥99.2%) and non-inferiority was demonstrated (lower bound of the 95% CI for the difference was -4.17, above the pre-defined delta [-10%]). Post-primary SP rates for anti-diphtheria (≥95.5% ≥0.01 IU/mL), anti-PRP (≥99.2% ≥0.15 μg/mL), and anti-Hep B ≥100 mIU/mL (≥93.9%), were similar in each group. Both vaccines were well tolerated. The incidence of serious adverse avents was low and similar in each group, and none was considered to be vaccine related. Conclusions: In a 2, 4, 6 month schedule in Peruvian infants, the investigational DTaP-IPV-Hep B-PRP-T fully liquid vaccine provided high immunogenicity for Hep B, diphtheria and PRP vaccine antigens that was comparable to the licensed hexavalent vaccine. Both vaccines had a similar safety profile.

Six months of zinc supplementation affects measures of attention in Peruvian infants at 12 months of age

To evaluate the effect of Zn status on cognitive development, we conducted a randomized controlled trial of Zn supplementation in Peruvian infants from 6 to 18 months of age. Healthy infants born at term were randomly assigned at 6 mo to consume a syrup containing 10 mg Fe + 0.5 mg Cu, with or without 10 mg Zn, daily for 12 mo. Various aspects of development were assessed over the one year period; here we focus on measures of visual attention, assessed at 6, 9 and 12 mo. Infants were administered a visual habituation task with simultaneous heart rate (HR) recording. Outcome measures included look duration and changes in HR-defined phases of attention. Infants in the zinc group showed the typical, normative decline in look duration from 6 to 12 mo, but the control group did not; with differences significant at 12 mo (P < 0.01). Similar treatment differences were observed for mean look duration (P< 0.006) and peak (longest) look duration (P< 0.008). Infant HR declined over age, but no differences in HR or HR-defined phases of attention were observed by supplement type. Overall, these preliminary results suggest that zinc supplementation affected behavioral measures of visual attention. Further analyses of cognitive outcomes at older ages may further our understanding of the effect of these alterations on infant cognitive development. Supported by HD045430.

Changes in iron and zinc status in Peruvian infants consuming an iron syrup with or without zinc from 6 to 18 months of age

Changes in iron and zinc status in Peruvian infants consuming an iron syrup with or without zinc from 6 to 18 months of age

Infant Nutrition and 12 and 18 Months Secure Base Behavior: An Exploratory Study

A notable omission in studies of developmental links to early nutritional deficiencies is infant attachment. In those few studies investigating associations between infant nutrition and attachment, nutrition was defined solely by physical growth, and infants had moderate-severe growth retardation. In this study, we utilized multiple markers of infant nutrition. Our sample consisted of 172 12-month-old Peruvian infants and their mothers from low-income families, with a follow-up assessment on 77 infants at 18 months. Infants were not severely malnourished, but did have micronutrient deficiencies. Anthropometry, dietary intake, and iron status were used as measures of infant nutrition. Based on infant behavior in a structured laboratory situation, Q-sort techniques were used to rate three attachment markers: infant secure base behavior, interaction quality, and negative emotionality with mother. At 12 months, infant weight was positively related to interaction quality. At 18 months, infant iron status was positively related to secure base behavior. This pattern of findings remained even after statistically controlling for family socioeconomic status and maternal education. Our findings indicate that infant nutritional status is associated with markers of infant attachment and these associations are not restricted just to severely malnourished infants.

Prenatal Maternal Zinc Supplements Reduce Infant Diarrhea

Research Article| October 01 2010 Prenatal Maternal Zinc Supplements Reduce Infant Diarrhea AAP Grand Rounds (2010) 24 (4): 43. https://doi.org/10.1542/gr.24-4-43 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Prenatal Maternal Zinc Supplements Reduce Infant Diarrhea. AAP Grand Rounds October 2010; 24 (4): 43. https://doi.org/10.1542/gr.24-4-43 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: infantile diarrhea, prenatal care, zinc supplement, diarrhea Source: Iannotti L, Zavaleta N, Leon Z, et al. Maternal zinc supplementation reduces infectious disease morbidity in Peruvian infants. J Pediatr. 2010; 156(6): 960– 964; doi: https://doi.org/10.1016/j. jpeds.2009.12.023Google Scholar Investigators from the US and Peru performed this double-blind randomized controlled trial in a peri-urban slum of Lima, Peru between 1995 and 1997 to assess the effect of zinc supplementation during pregnancy on subsequent infectious diseases through infancy. Researchers enrolled 1,295 women between 10 and 24 weeks gestation who were carrying a low-risk singleton pregnancy. These women were stratified by gestational age (less than or more than 17 weeks) and parity (nulliparous or multiparous) and then randomized to take a daily supplement of 60 mg of iron and 250 μg of folic acid either with or without 15 mg of zinc. The two tablets were otherwise indistinguishable, and were taken from 10 to 24 weeks gestation until one month postpartum. Socioeconomic and household characteristics and maternal anthropometric measurements were recorded. Infant weights were recorded at birth and then monthly for 12 months. Morbidity surveillance was done by field workers through weekly home visits. Of the 421 infants who completed the 12-month study, 214 received zinc supplementation. There were no differences between the zinc-supplemented and control groups with regard to socioeconomic or household characteristics, gestational age at birth, or birth weight. Adjusting for the age of the infant, breastfeeding, season, and sanitation and hygiene covariates, prenatal zinc supplementation reduced the risk of a diarrheal episodes lasting more than seven days by 34% (OR 0.66; 95% CI, 0.43–0.99; P=.04) and decreased the presence of mucus in the stool (OR 0.65; 95% CI, 0.46–0.92; P=.01) as compared to controls. The mean observed days with diarrhea among infants prenatally treated with zinc (5.8%) was less than infants in the control group (7.7%; P=.01). There was a trend toward fewer diarrheal episodes (≥3 liquid or loose stools in 24-hour period) in the prenatal zinc-supplemented group. No effect was detected for respiratory illnesses, fever, scabies, or impetigo. The authors conclude that prenatal zinc supplementation decreased diarrhea-associated morbidity in offspring during the first 12 months of life. In 2009, the World Health Organization recommended that zinc be added to oral rehydration therapy in the treatment of acute diarrhea. 1 The authors of this article propose an immunological basis to explain the beneficial effect from prenatal zinc supplementation. Zinc deficiency in humans decreases the activity of serum thymulin (a thymic hormone), which is required for maturation of T-helper cells and plays an important role in cell-mediated immune function and also functions as an anti-inflammatory and antioxidant agent.2 Infectious diarrheal diseases are the second leading cause of morbidity and mortality worldwide.3 Zinc deficiency places children at increased risk of illness and death from diarrhea.4 Zinc deficiency is prevalent in low-income countries, as this micronutrient is mainly found in expensive red meat. Pooled analysis of studies that have assessed the effect of... You do not currently have access to this content.

Maternal Zinc Supplementation Reduces Diarrheal Morbidity in Peruvian Infants

To test whether zinc supplementation during pregnancy would reduce infant morbidity rates. A double-blind, randomized controlled trial of prenatal zinc supplementation was conducted from 1995 to 1997 in a periurban slum of Lima, Peru. Participants were randomly assigned to receive daily supplementation with zinc (15 mg zinc + 60 mg iron + 250 microg folic acid) or placebo (60 iron + 250 microg folic acid) from 10 to 24 weeks gestation until 1 month postpartum. Anthropometry was measured monthly from birth through age 12 months, and morbidity and dietary intake were measured weekly from 6 to 12 months (n = 421). The average percentage of observation days with diarrhea among infants prenatally treated with zinc (5.8%) was reduced compared with infants in the control group (7.7%) (P = .01). Prenatal zinc supplementation reduced the likelihood of an infant experiencing diarrheal episodes of acute diarrhea lasting longer than 7 days (OR 0.66, 95% CI 0.43, 0.99, P = .04) and mucus in the stool (OR 0.65 95% CI 0.46, 0.92, P = .01) adjusting for infant age, breastfeeding, season, and hygiene and sanitation covariates. No treatment effects on respiratory illnesses, fever, or skin conditions were detected. Improving prenatal zinc nutrition protected against diarrheal morbidity in infant offspring through 12 months of age.

Growth and Body Composition of Peruvian Infants in a Periurban Setting

Previous growth studies of Peruvian children have featured high stunting rates and limited information about body composition. We aimed to characterize anthropometric measures of Peruvian infants 0 to 12 months of age in relation to the international growth references and biological, environmental, and socioeconomic factors. Infants (n = 232) were followed longitudinally from birth through 12 months of age from a prenatal zinc supplementation trial conducted in Lima, Peru, between 1995 and 1997. Anthropometric measures of growth and body composition were obtained at enrollment from mothers and monthly through 1 year of age from infants. Weekly morbidity and dietary intake surveillance was carried out during the second half of infancy. The prevalence rates of stunting, underweight, and wasting did not exceed 4% based on the World Health Organization growth references. Infants of mothers from high-altitude regions had larger chest circumference (p = .006) and greater length (p = .06) by 12 months. Significant predictors of growth and body composition throughout infancy were age, sex, anthropometric measurements at birth, breastfeeding, maternal anthropometric measurements, primiparity, prevalence of diarrhea among children, and the altitude of the region of maternal origin. No associations were found for maternal education, asset ownership, or sanitation and hygiene factors. Peruvian infants in this urban setting had lower rates of stunting than expected. Proximal and familial conditions influenced growth throughout infancy.

Maternal zinc supplementation and growth in Peruvian infants

BackgroundLittle is known about how maternal zinc intake influences growth in utero and in postnatal life in humans. ObjectiveWe aimed to assess the effect of maternal zinc supplementation during pregnancy on infant growth through age 1 y. DesignA double-blind, randomized controlled trial of prenatal zinc supplementation was conducted from 1995 to 1997 in Lima, Peru. Women (n = 1295) were enrolled at 15.6 ± 4.6 wk gestation and assigned to receive daily supplements with zinc (15 mg Zn + 60 mg Fe + 250 μg folic acid) or without zinc (60 Fe + 250 μg folic acid) through pregnancy to 1 mo after delivery. At birth, 546 infants were followed for 12 mo to assess growth. Anthropometric measures of body size and composition were collected monthly, and morbidity and dietary intake surveillance was carried out weekly. ResultsNo differences in maternal socioeconomic characteristics by treatment group or follow-up period were found. Infants born to mothers prenatally supplemented with zinc had significantly (P < 0.05) larger average growth measures beginning in month 4 and continuing through month 12. In longitudinal regression modeling, prenatal zinc was associated with greater weight (by 0.58 ± 0.12 kg; P < 0.001), calf circumference (by 1.01 ± 0.21 cm; P < 0.001), chest circumference (by 0.60 ± 0.20 cm; P = 0.002), and calf muscle area (by 35.78 ± 14.75 mm2; P = 0.01) after adjustment for a range of covariates. No effect was observed for linear growth. ConclusionMaternal zinc supplementation in this population was associated with offspring growth, which is suggestive of lean tissue mass accretion.

Metabolomics of plasma and urine samples from Peruvian infants receiving dietary zinc supplements

Metabolomics of plasma and urine samples from Peruvian infants receiving dietary zinc supplements

Iron Deficiency, but Not Anemia, Upregulates Iron Absorption in Breast-Fed Peruvian Infants

Iron absorption in adults is regulated by homeostatic mechanisms that decrease absorption when iron status is high. There are few data, however, regarding the existence of a similar homeostatic regulation in infants. We studied 2 groups of human milk-fed infants using (57)Fe (given as ferrous sulfate without any milk) and (58)Fe (given at the time of a breast-milk feeding) stable isotopes to determine whether healthy infants at risk for iron deficiency would regulate their iron absorption based on their iron status. We studied 20 Peruvian infants at 5-6 mo of age and 18 infants at 9-10 mo of age. We found no effect of infant hemoglobin concentration on iron absorption with 5-6 mo-old infants absorbing 19.2 +/- 2.1% and 9- to 10-mo-old infants absorbing 25.8 +/- 2.6% of the (57)Fe dose. For (58)Fe, 5- to 6-mo-old infants absorbed 42.6 +/- 5.0% and 9 to 10-mo-old infants absorbed 51.9 +/- 10.3%. Following log transformation, iron absorption from (57)Fe (r = -0.61, P = < 0.001) and (58)Fe (r = -0.61, P = < 0.001) were inversely correlated to serum ferritin (S-Ft). For both the (57)Fe and (58)Fe doses, infants with S-Ft <12 mg/L (n = 11) had significantly higher iron absorption than those with S-Ft >12 mg/L. We concluded that iron absorption in infants is related to iron status as assessed by serum ferritin but not hemoglobin concentration. Infants with low iron status upregulate iron absorption from breast milk at both 5-6 and 9-10 mo of age.

Longitudinal measures of ghrelin and leptin are associated with growth of Peruvian infants 6–14 months of age

Ghrelin and leptin are hormonal regulators of energy balance and therefore may be related to growth during infancy. As part of a zinc intervention trial, we measured plasma ghrelin, leptin, weight, length, and energy intake 3 times at 3-month intervals (T1,T2,T3) among 105 breast-fed infants aged 6–8 months initially who were at risk of stunting (length-for-age Z-score, LAZ <-0.5). Children were randomly assigned to receive 3 mg additional zinc/d, either as a supplement or in a fortified food, or a placebo. Separate regression analyses were conducted to determine if changes in weight-for-age Z-score (WAZ) were predictive of hormone levels or vice versa, controlling for the respective initial values and infant sex. There was no effect of zinc treatment on hormone levels. Ghrelin levels at T2 and T3 were negatively associated with changes in WAZ during the previous time periods, and leptin levels were positively associated with changes in WAZ during the previous time periods (p<0.01). Females had significantly higher leptin levels than males at T2 and T3 (p<0.05), even after controlling for BMI. Hormone levels were not related to subsequent changes in WAZ, changes in LAZ, or daily energy intake at any time. In conclusion, zinc intake did not affect plasma leptin and ghrelin levels in this population. It appears that ghrelin and leptin levels may respond to prior weight gain in late infancy, although these hormones do not predict subsequent growth. Supported by Bill & Melinda Gates Foundation

Efficacy of Multiple Micronutrient Supplementation for Improving Anemia, Micronutrient Status, Growth, and Morbidity of Peruvian Infants

Anemia, micronutrient deficiencies, and growth faltering are still common in Peru. The study objective was to determine the efficacy of different micronutrient supplements in preventing growth failure, anemia, and micronutrient deficiencies in Peruvian infants. Three hundred and thirteen infants aged 6 to 12 mo participated in a double-blind, masked, controlled trial in which they were randomly assigned to receive either a daily dose of iron (DI), a daily dose of multiple micronutrients (DMM), a weekly dose of multiple micronutrients, or a placebo (P) for 6 mo. None of the supplements tested prevented growth faltering or the morbidities common during infancy. Anemia and plasma homocysteine concentrations fell significantly in all groups during the study, but the mean change of plasma homocysteine during the trial period was significantly smaller in the DI group than in other groups, and the increase in hemoglobin concentrations was smaller in the P group than the micronutrient treatment groups. Plasma ferritin concentrations decreased least in the groups taking daily micronutrient supplements containing iron (DI and DMM). There were no significant differences among groups in mean final values or changes in plasma zinc, retinol, tocopherol, or riboflavin. Although the DMM intervention was the most efficacious for preventing anemia, iron, and zinc deficiencies, 15%, 20%, and 50% of this group still remained anemic, zinc deficient, and iron deficient, respectively, at the end of the study. Further research thus should investigate whether higher doses of iron and zinc, together with infection control measures, are more efficacious.

Structure and cross-contextual stability of neonatal temperament

Using a sample of 249 newborn Peruvian infants we investigated the stability and factorial structure of neonatal temperament, assessed in two different settings during the first week of life. While neonates were still in the hospital their behavior during a structured anthropometry examination was videotaped and subsequently coded on four temperament dimensions: activity level, negative emotionality, alertness and soothability. The same dimensions were coded using a videotape obtained during a subsequent visit to the neonates home. Results indicated that while there was modest stability of temperament across the two settings levels of neonatal temperament also varied across settings, with increased distress and reduced soothability in the more stressful laboratory examination and increased levels of alertness during the unstructured home observation. Across both settings neonatal temperament was defined by a primary component linking alertness and soothability with a reverse loading for irritability. We interpret this component as an early precursor of self-regulation. However, our results indicate that the structure of neonatal temperament also is sensitive to setting, with the second identified component linking activity level to irritability in the laboratory assessment and with alertness in the home observation. Results are discussed with reference both to current theories of the development of temperament and to the importance of assessment of contextual characteristics when assessing temperament, even in the neonatal period.

An Overlap of Breastfeeding during Late Pregnancy Is Associated with Subsequent Changes in Colostrum Composition and Morbidity Rates among Peruvian Infants and Their Mothers

An overlap of breast-feeding and late pregnancy is associated with decreased intake of human milk and reduced infant growth. We evaluated the association of an overlap with macronutrient and immunological components of milk, infant urinary IgA, and infant and maternal morbidity. On d 2 and 1 mo postpartum, staff measured 24-h intake of breast milk and collected samples from 133 Peruvian women; 68 had breast-fed during the last trimester of pregnancy (BFP) and 65 had not breast-fed during pregnancy (NBFP). Data on maternal and infant anthropometry and health were collected for 1 mo. On d 2, lactose and lysozyme concentrations were higher, total lysozyme intake was higher and concentration and total intake of lactoferrin were lower in the BFP than the NBFP group (P < 0.05). The total 1-mo IgA intake was lower among BFP than NBFP infants (P = 0.01). Urinary IgA concentration was correlated with breast milk IgA concentration (r = 0.29; P = 0.01) but not with breast-feeding during pregnancy. An overlap was not associated with diarrhea but BFP infants were 5 times as likely to have a cough for at least 7 d than NBFP infants (P < 0.05). Reported mastitis was rare and occurred only in the NBFP group (P = 0.05). An overlap of breast-feeding and late pregnancy was associated with changes in milk composition, an increased frequency in symptoms of infant respiratory illness but decreased reported mastitis. Further in-depth studies are warranted to determine the cumulative effects associated with a breast-feeding/pregnancy overlap on infant and maternal outcomes.

Oligofructose-supplemented infant cereal: 2 randomized, blinded, community-based trials in Peruvian infants

Prebiotics are nondigestible food ingredients that stimulate the growth of Bifidobacterium and other bacteria in the gastrointestinal tract. Improved gastrointestinal and other health effects have been attributed to them. The objective of this study was to evaluate the effects of dietary supplementation with the prebiotic oligofructose with and without zinc on the prevalence of diarrhea in a community with a high burden of gastrointestinal and other infections. Two consecutive randomized, blinded, controlled clinical trials were performed in a shantytown community near Lima, Peru. The first trial compared an infant cereal supplemented with oligofructose (0.55 g/15 g cereal) with nonsupplemented cereal. During the second trial, zinc (1 mg/15 g cereal) was added to both oligofructose-supplemented and control cereals. We enrolled 282 infants in the first trial and 349 in the second. In the first trial, mean (+/- SD) days of diarrhea were 10.3 +/- 9.6 in the nonsupplemented cereal group and 9.8 +/- 11.0 in the prebiotic-supplemented cereal group (P = 0.66). In the second trial, mean days of diarrhea were 10.3 +/- 8.9 in the group consuming cereal fortified only with zinc and 9.5 +/- 8.9 in the group consuming cereal containing both zinc and prebiotics (P = 0.35). Postimmunization titers of antibody to Haemophilus influenzae type B were similar in all groups, as were gains in height, visits to clinic, hospitalizations, and use of antibiotics. Cereal supplemented with prebiotics was not associated with any change in diarrhea prevalence, use of health care resources, or response to H. influenzae type B immunization. Infants and young children who continue to breast-feed may not benefit from prebiotic supplementation.