Unmodified Cow's Milk Research Articles

Associations between breastfeeding duration and adherence to complementary feeding recommendations in Scotland.

We aimed to describe how breastfeeding relates to adherence to complementary feeding (CF) recommendations, diet diversification and feeding skills development and whether sociodemographic factors explain any differences observed. The Scottish Maternal Infant and Nutrition Survey for infants aged 8-12 months collected breastfeeding history, CF practices, diet and sociodemographic data using a self-completion questionnaire. Non-healthful CF practices were starting CF < 6 months, any consumption of sugar-sweetened beverages (SSBs), sweet or salty snacks (treats) or unmodified cow's milk and regular consumption of commercial baby foods. Diet diversification and feeding skills were assessed by amount of self-feeding and number of food groups, meals and snacks eaten daily. Of the 2730 mothers, 20% were solely infant formula fed (IFF) and 48% continued breastfeeding ≥6 months. Compared to IFF babies, mothers who gave any breast milk ≥6 months were more likely to start CF ≥ 6 months compared to those IFF (66% vs. 37%) and less likely to give treats (15% vs. 45%), SSBs (11% vs. 20%) and commercial baby foods (31% vs. 53%). These associations remained highly significant (p < 0.001) even after sociodemographic factor adjustment. Despite starting CF later, infants breastfed ≥6 months ate the same number of food groups and meals as those IFF, were just as likely to self-feed purees and more likely to self-feed finger foods daily (87% vs. 81% p < 0.001). Mothers who breastfeed beyond 6 months adhere more to CF recommendations and start CF later compared to IFF, but their babies eat a similarly diverse diet and have similar feeding skills.

Iron supplementation given to nonanemic infants: neurocognitive functioning at 16 years

ABSTRACT Objective There is concern that high iron uptake during the critical period of early brain development carries potential risks, especially for nonanemic infants. This study examined the neurocognitive functioning of 16-year-olds who were nonanemic as infants and received iron supplementation. Methods We studied 562 Chilean adolescents (M 16.2 years; 52.7% female) who participated in a randomized controlled iron supplementation trial in infancy. Between 6 and 12 months, 346 consumed an iron-fortified formula (12.7 Fe mg/L) or, if primarily breastfed, liquid vitamins with 15 mg elemental iron as ferrous sulfate, and 216 consumed unmodified cow milk without iron or liquid vitamins without iron if primarily breastfed. Results Compared to adolescents in the no-added iron condition in infancy, those in the iron-supplemented condition had poorer visual-motor integration, quantitative reasoning skills, and incurred more errors on neurocognitive tasks. Consuming larger amounts of iron-fortified formula in infancy was associated with lower arithmetic achievement. Of adolescents who had high hemoglobin at 6 months (Hb ≥ 125 g/L), those in the iron supplemented condition had poorer performance on arithmetic, quantitative reasoning, and response inhibition tests than those in the no-added iron condition. Of adolescents who had marginally low 6-month hemoglobin (Hb > 100 and < 110 g/L), those who received no-added iron incurred more errors on a visual searching task than those in the iron-supplemented condition. Conclusion The physiologic need for iron during the period of rapid and critical brain development in young infants should be considered vis-à-vis the risks associated with supplementing nonanemic infants with high levels of iron. Clinical Trials number: NCT01166451

The nutrient requirements of Lactobacillus rhamnosus GG and their application to fermented milk

Lactobacillus rhamnosus GG (LGG) performs many physiological functions, but the fermentation time is long when fermented milk is prepared using LGG alone. To shorten the fermentation time, we analyzed the nutrient requirement profiles of LGG. Based on nutrient requirement profiles, we evaluated the effects on the fermentation time, quality, and sensory properties of unmodified cow's milk fermented by LGG alone. According to the consumption and necessary patterns of amino acids and those of purine, pyrimidine, vitamins, metal ions, and nutrients essential to LGG, we selected Cys, Ser, Arg, Pro, Asp, Glu, guanine, uracil, and xanthine with which to supplement milk. Compared with fermented milk prepared using LGG alone in unmodified milk, the fermentation time of supplemented milk was shortened by 5 h. Viable cell counts, titratable acidity, and water-retaining capability of the fermented milk were improved by addition of nutrient supplements. Supplementation with nutrients did not obviously change the sensory and textural characteristics of fermented milk.

Health and food safety concerns of early dietary introduction of unmodified cow milk to infants in developing countries

The timing of introduction of unmodified cow milk is critical in infant feeding. The objective of this review is to explore the underlying reasons f or the early dietary introduction of unmodified cow milk to infant diets in the sub- Saharan African countries and also to assess the health and food safety concern s for its early introduction. Public health organisations including the America n Academy of Paediatrics recommend that unmodified cow milk should not become part of infant diet before 12 months. Despite the recommendations and the evidence for an increased risk of multiple adverse health outcomes, the prevalence of early weaning and the early introduction of unmodified cow milk remain high in sub-Saharan African countries such as Uganda, Kenya and Ethiopia. Return to paid employment, inconsistent infant feeding advice from clinical professionals and maternal sickness are often the registered reasons by the mothers for the early introduction of breast milk substitutes. Therefore, parents should be educated on the health and food safety concerns of early introduction of unmodified cow milk. Unlike breast milk, unmodified cow milk does not provide a balanced diet for infant s aged below 12 months. It contains excessive levels of protein, sodium, potassium, phosphorus, and calcium and insufficient levels of iron, vitamin C, and linoleic acid for human infant requirements. Consequently, the early introduction of unmodified cow milk is associated with risks of iron deficiency anaemia, protein-induced enterocolitis syndrome and increased renal solute load. Moreover, the introduction of unmodified cow milk into the infant diets should be delayed as long as possible to prevent the nutritional, health and food safety risks associated with its earlier introduction. It is also important that exclusive breastfeeding for 6 months in sub -Saharan African countries is promoted as it will extend breastfeeding benefits of prevention of iron deficiency anaemia and provide protection against infant nutritional childhood infections. Mothers should also be taught about proper infant feeding practices.

Modified milk for infants

Purpose – Breast milk is considered as the most ideal food for infants during infancy owing to its diverse nutritional and therapeutic attributes. In the absence of breast milk, infants may be offered with cow's, buffalo's or goat's milk after modification to bring their composition nearer to human milk. The paper aims to discuss these issues. Design/methodology/approach – Risks associated with prolonged and exclusive breast feeding or unmodified cow's, buffalo's or goat's milk have been highlighted. In the absence of human milk, the suitability of modified cow's, buffalo's or goat's milk as a supplementary food for infants is also justified. Findings – Breast milk is the most preferred food for infants owing to its numerous intrinsic therapeutic and nutritional attributes. Human milk is virtually impossible to mimic completely, and therefore, goat's milk is often preferred over cow's milk or buffalo's milk due to its better digestibility, higher biological value and less allergenic. An appropriate blending of protein, carbohydrate, fat, minerals and vitamins to cow's, buffalo's or goat's milk to result in modified milk, nutritionally adequate for infants is suggested. Originality/value – Nutritional and therapeutic attributes of cow's, buffalo's or goat's milk must be suitably modified to meet the physiological needs as well as to confer protection to the infants.

Iron Requirements of Infants and Toddlers

Iron deficiency (ID) is the most common micronutrient deficiency worldwide and young children are a special risk group because their rapid growth leads to high iron requirements. Risk factors associated with a higher prevalence of ID anemia (IDA) include low birth weight, high cow's-milk intake, low intake of iron-rich complementary foods, low socioeconomic status, and immigrant status. The aim of this position paper was to review the field and provide recommendations regarding iron requirements in infants and toddlers, including those of moderately or marginally low birth weight. There is no evidence that iron supplementation of pregnant women improves iron status in their offspring in a European setting. Delayed cord clamping reduces the risk of ID. There is insufficient evidence to support general iron supplementation of healthy European infants and toddlers of normal birth weight. Formula-fed infants up to 6 months of age should receive iron-fortified infant formula, with an iron content of 4 to 8 mg/L (0.6-1.2 mg(-1) · kg(-1) · day(-1)). Marginally low-birth-weight infants (2000-2500 g) should receive iron supplements of 1-2 mg(-1) · kg(-1) · day(-1). Follow-on formulas should be iron-fortified; however, there is not enough evidence to determine the optimal iron concentration in follow-on formula. From the age of 6 months, all infants and toddlers should receive iron-rich (complementary) foods, including meat products and/or iron-fortified foods. Unmodified cow's milk should not be fed as the main milk drink to infants before the age of 12 months and intake should be limited to <500 mL/day in toddlers. It is important to ensure that this dietary advice reaches high-risk groups such as socioeconomically disadvantaged families and immigrant families.

Nutritional status of babies and influence of unmodified cow's milk on allergic reactions according to the epidemiological study from Ukraine

Introduction: Recently in most countries there has been a continuous increase in the number of various allergic diseases. Early introduction of unmodified cow's milk (UCM) into the baby's diet may provoke the development of food allergies, allergic and food hypersensitivity reactions. Aim: The aim of our study was to examine the peculiarities of baby's nutrition in Ukraine, to estimate the impact of early cow's milk proteins (CMP) consumption on frequency of food hypersensitivity and allergic reactions in toddlers within two years of life, depending on the time of CMP introduction. Materials and methods: 5354 full term infants aged of 1–12 months were enrolled into the crosssectional study. Retrospective evaluation of incidences of food hypersensitivity and allergic reactions was done in a selected cohort of 1000 babies who were divided into 3 groups depending on their nutrition. 135 babies did not receive UCM (the first group). 471 – received UCM during the first year of life (the second group). 394 babies were fed with UCM starting from the second year of life (the third group). Results: Significant difference on frequency of food hypersensitivity reactions we found in 1, 2, 3 groups of toddlers when they consumed products that contained cow's milk protein (2.99% vs. 7.64% and 10.94%; p=0.01); eggs (2.22% vs. 8.49% and 10.41%; p=0.013); citrus (6.67% vs. 19.96% and 18.78%; p=0.001); chocolate (2.96% vs. 13.61% and 14.5%; p=0.002) and some other foods (4.44% vs. 14.01% and 10.41%; p=0.006). Conclusions: Introduction of UCM into baby's diet during the first and second year of life is associated with increased risk of a variety of allergic and food hypersensitivity reactions, accompanied by a higher frequency of hospitalizations and taking medications.

Pattern of milk feeding and family size as risk factors for iron deficiency anemia among poor Egyptian infants 6 to 24 months old

Infants between 6 and 24 months of age are at the highest risk of development of iron deficiency anemia (IDA) in developing countries. Consuming unmodified cow's milk, delayed introduction of solid foods after 6 months, and high birth order could be predictors of the presence of IDA. Three hundred infants between the ages of 6 and 24 months (mean, 13.94 ± 6.17 months) from Ain Shams University Children's Hospital were enrolled in the study. Data collected included demographic information and dietary assessment including the type of milk feeding, introduction of solid foods, and daily iron intake. The infants were examined, and anthropometric measurements were recorded. Anemic infants (hemoglobin level <11 g/dL) were further evaluated by complete blood count, hemoglobin electrophoresis, and iron profile. Anemia was diagnosed among 198 infants (66%), of whom 129 (43%) had IDA. Red cell distribution width at a cutoff value of 15.8% was 86% sensitive and 74% specific in predicting IDA. The main risk factors for IDA included being between 6 and 18 months of age, of the male sex, birth order above the second order, consuming cow's milk, predominant breast-feeding beyond 6 months of age, and low daily iron intake. We conclude that IDA is the most common cause of anemia among Egyptian infants 6 to 24 months old of low socioeconomic standard. Independent clinical predictors were consuming cow's milk during the first 6 months, delayed introduction of solid foods after 6 months, and birth order beyond the second order.

Effect of Unmodified Cow's Milk Intake During the First 20 Months of Life on Infants' and Toddlers' Morbidity

An optimal age at which unmodified caw's milk could be introduced into the baby's diet remains contradictory. The aim of the study was to estimate the possible negative influence of unmodified caw's milk (UCM) intake on morbidity and incidence of food hypersensitivity reactions during the first 20 months of life. Methods: Retrospective evaluation of morbidity, incidences of food hypersensitivity reactions was done in a cohort of 1000 babies who were divided into 3 groups depending on their nutrition. 135 babies did not receive UCM for the 20 months (the first group). 471 received UCM during the first year of life (the second group). 394 babies were fed with UCM starting from the second year of life (the third group). Medical record reviews were performed and special questionnaire was used. Results: Babies from the first group had lower incidence of food hypersensitivity reactions (17,04% vs. 49,26% and 51,52% in the 2nd and 3rd groups accordingly; ?< 0,001). The incidences of diarrhoea (4,48% vs. 17,2% and 13,23% accordingly; ?=0,014), pneumonia (0,11 ± 0,39 vs. 0,26 ± 0,6 and 0,22 ± 0,7 episodes; ?=0,046), average number of hospitalizations (0,25 ± 0,64 vs. 0,56 ± 1,0 and 0,46 ± 0,79; ?=0,0035) and antibiotics administration (0,57 ± 0,99 vs. 1,23 ± 1,5 and 1,22 ± 1,21 courses; ?=0,0001) were also different in the groups. Conclusions: Introduction of UCM into baby's diet during the first 2 years of life may lead to increased hypersensitivity reaction incidence, infectious morbidity, numbers of hospitalization and courses of antibiotics administration.

Determinants of Early Weaning and Use of Unmodified Cow's Milk in Infants: A Systematic Review

Introduction of complementary foods (weaning) before 4 to 6 months of age and unmodified cow's milk before age 12 months are associated with several health risks. To develop effective interventions to discourage these practices, evidence of their determinants is needed. This systematic review identified documents from seven electronic databases (database inception 2008) and reference lists, and by contacting authors. Seventy-eight studies in developed countries, published between 1976 and 2008, quantifying the association between either feeding practice and its potential determinants were included. Study quality was systematically assessed in terms of representativeness, sample size, method of outcome ascertainment, and approach to statistical analysis. The distribution of evidence for each determinant was visualized in a harvest plot showing the strength and direction of associations found and the quality of relevant studies. The strength of evidence for each determinant was summarized as strong, moderate, limited, or inconclusive, using an algorithm based on the consistency of the results of studies of the highest available quality. Strong evidence denoted that the determinant was examined in three or more high-quality studies and ≥75% of results were consistent. Strong evidence was found for six determinants of early weaning (ie, young maternal age, low maternal education, low socioeconomic status, absence or short duration of breastfeeding, maternal smoking, and lack of information or advice from health care providers) and for two determinants of early introduction of unmodified cow's milk (ie, low maternal education and low socioeconomic status). Of these determinants, improving advice given by health care providers appears the most tractable area for intervention in the short term.

Ingesta de una fórmula láctea suplementada con hierro como medida preventiva del déficit de hierro en niños de 1 a 3 años de edad

Low iron status is a well known risk factor for iron deficiency anemia in infants and young children. The aim of the present study was to evaluate the influence of an iron-fortified toddler formula on iron status in 1-3 year-olds.Thirty-three healthy infants and young children were assigned to two groups that received 500 mL/day of and iron-fortified toddler formula or 500 mL/day of unmodified cow's milk for 4 months. Allocation was random and double-blind. Daily dietary intake was calculated by dietary evaluation, and iron nutritional status was assessed (hemoglobin, hematocrit, mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, serum iron, ferritin, and transferrin).At enrollment, no anemia was found in either group, although hemoglobin concentration and hematocrit were significantly lower in the toddler formula group than in the unmodified cow's milk group. However, these differences disappeared at the end of the intervention period. After 4 months, the toddler formula group showed significantly higher serum ferritin and lower serum transferrin concentrations than the cow's milk group.Intake of iron-supplemented toddler formula for 4 months in 1-3 year-olds is more effective in maintaining iron nutritional status than cow's milk.

Iron deficiency anaemia: does it really matter?

Iron deficiency is common in inner city areas in 2-year-olds in the UK and is almost exclusively related to poor feeding practices, with inappropriate carbohydrate-rich food, late weaning, and an excess of unmodified cow's milk containing no available iron. The potential seriousness of iron deficiency is often ignored, but it can lead to a poor neurodevelopmental outcome, poor growth and recurrent infections. It is best managed by advice on weaning onto iron-rich foods and avoidance of large intake of unmodified milk. There is a strong case for screening in poorer areas, and the provision of routine iron supplementation to vulnerable populations in parallel with the currently recommended vitamin supplementation.

The role of fermented milk in complementary feeding of young children: lessons from transition countries.

Probiotic bacteria are used for production of fermented dairy products. The use of probiotic bacteria has the potential to replenish the natural intestinal flora of the body. These bacteria competitively inhibit the growth and colonization of pathogenic bacteria. Breastmilk is the best food for babies, also from a probiotic point of view. Human milk, in fact, contains many substances that stimulate the growth of bifidobacteria in vitro and in the small intestine of infants. Improvement of lactose digestion and avoidance of symptoms of intolerance in lactose malabsorbers are the most profoundly studied health-relevant effects of fermented milk. In fact fermented milks are nutritionally similar to unfermented milk, except that some of lactose is broken down to glucose and galactose. The role of fermented milk in complementary feeding and in particular for the prevention of anaemia is an innovative theme, recently focused. Iron deficiency in infants and young children is widespread and has serious consequences for child health. Prevention of iron deficiency should therefore be given high priority. The too-early introduction of unmodified cow's milk and milk products is an important nutritional risk factors for the development of iron-deficiency anaemia. Fermented milks represent an excellent source of nutrients such as calcium, protein, phosphorus and riboflavin. During the fermentation of milk, lactic acid and other organic acids are produced and these increase the absorption of iron. If fermented milk is consumed at mealtimes, these acids are likely to have a positive effect on the absorption of iron from other foods.

A Longitudinal Study of Breastfeeding and Weaning Practices During the First Year of Life in Dunedin, New Zealand

Objective To investigate infant feeding practices during the first year of life in a group of white infants in Dunedin, New Zealand.Design Prospective study of infants from birth to 12 months of age.Participants A self-selected sample of 74 white mothers and their infants born in Dunedin, New Zealand, between October 1995 and May 1996.Statistical analyses Regression analyses were performed to determine factors associated with successful breastfeeding initiation and duration.Results Among mothers, 88% (n=65) initiated breastfeeding, 42% (n=31) were exclusively breastfeeding at 3 months, and 34% (n=25) were partially breastfeeding at 12 months. Intention to breastfeed increased the likelihood of successful breastfeeding initiation. Mothers who reported that they did not have enough breastmilk tended to exclusively breastfeed for a shorter period of time. Tertiary education and exclusively breastfeeding at 1 month were associated with a longer duration of breastfeeding. Perception of breastfeeding in public as embarrassing was associated with a shorter duration of breastfeeding. Among infants, 45% (n=33) were given nonmilk foods before 4 months of age, and 69% (n=51) were given unmodified cow's milk as a beverage before 12 months.Applications Breastfeeding rates in this study, although higher than in many Western countries, were still lower than current recommendations. Our findings suggest that women should be taught how to increase their breastmilk supply. Parents should also be informed of the importance of delaying the introduction of nonmilk foods until their infant is 4 to 6 months of age and cow's milk until they are 12 months of age. Society also needs to address the social issue of embarrassment many mothers feel when breastfeeding in public. J Am Diet Assoc. 2002;102:937-943.

Is Milk Best for Infants and Toddlers

Tower Hamlets is a deprived inner city area with a high level of ethnic minority groups, and has many nutritional problems. Iron deficiency and rickets are among the commonest seen. One of the main causes remains late or inappropriate weaning, as indicated in research carried out 15 years ago in Tower Hamlets and, as a result, an undue reliance on unmodified cow's milk, usually given in a bottle, for the first 2-3 years of life. Late weaning results in difficulties with chewing and swallowing, and as a direct consequence speech and language therapy is often needed to help overcome the problem. The danger of drinking excessive amounts of unmodified cow's milk is discussed, together with the controversies surrounding the possible long-term consequences of iron deficiency. Rickets continues to occur, and much of this stems from ignorance on the part of both parents and health professionals about current Department of Health guidelines for vitamin supplementation, and a prolonged exposure to unmodified cow's ...

Protein in infant formulas. Future aspects of development.

Cow's milk protein intolerant infants (CMPI), shifted to a cow's milk protein hydrolysate based formula, often experience an improvement in signs of malabsorption; on the other hand, they also present a pattern of watery stools. In an attempt to find high levels of some gastrointestinal hormones that might induce hypermotility, motilin and neurotensin levels were studied in infants on starting formula and in cow's milk protein intolerant infants, on a cow's milk protein hydrolysate based formula. In 12 infants on unmodified cow's milk based formula (starting formula), motilin levels were: mean 71.66 pmol/L (s: 17); neurotensin 26.53 (s: 10.9). In 19 cow's milk protein intolerant infants on a cow's milk protein hydrolysate based formula, motilin levels were: mean 163.65 pmol/L (s: 70.06) (p<0.05); neurotensin: 31.76 pmol/L (s: 15.03) (p>0.05). Motilin (but not neurotensin) is higher in cow's milk protein intolerant infants on a cow's milk protein hydrolysate based formula. We conclude that high motilin levels can induce a different pattern of motility, and can be a pathogenetic factor in the persistence of loose and watery stools in infants with CMPI on a protein hydrolysate based formula.

High Absorption of Fortification Iron From Current Infant Formulas

ABSTRACTBackground:Estimations of iron absorption from infant formulas are based on 20‐year‐old data. Data about iron bioavailability from currently used infant formulas are scarce, considering that during the last decades, formulas have had modifications that could affect iron absorption.Methods:Bioavailability of isotopically labeled iron (55Fe and 59Fe) from several infant formulas administered to contraceptive‐using women between the ages of 30 to 50 years was measured. Six infant formulas and one follow‐on formula were compared with a powdered, whole cow's milk, and the results were normalized to an absorption of 40% from a reference dose of iron.Results:Iron bioavailability from the infant formulas was consistently higher (19%), contrasting with the low value (4%) of the unmodified cow's milk (p&lt;0.0001). Iron absorption of the follow‐on formula was intermediate (13%). Formulas with 8 mg/l iron and one with 7 mg/l supply approximately 1 mg of absorbed iron, assuming a consumption of 750 ml/day of formula. This amount covers the iron needs of most infants during their period of greatest vulnerability. Formulas containing 12 mg/l iron would allow the absorption of approximately twice the infant iron requirements.Conclusions:Current infant formulas have a high iron bioavailability, which is an appealing argument for lowering the level of iron fortification in these products.

Clinical manifestations of nutritional copper deficiency in infants and children

A series of reports in the 1960s highlighted nutritional copper deficiencies in infants and children recovering from malnutrition in Peru; since that time, a cascade of additional cases in premature infants, in patients receiving total parenteral nutrition, and in those receiving special diets or unmodified cow milk have been reported. The identification by Danks that Menkes syndrome, a genetically determined defect in copper absorption and utilization, is responsible for the observed clinical manifestations provided further insight into the physiopathologic effects of copper deficiency. New information on the metabolism and physiologic role of copper, plus the identification of additional copper metalloenzymes and improvement in how to determine copper status, has fueled interpretation and speculation on how and why the classic signs of copper deficiency occur, as well as on the possible effects of mild deficiencies. Also under scrutiny are potential interactions between other elements and the effects of other elements, even when given in acceptable amounts, on copper status. There should be no constraints in thinking on other possible effects of impaired copper status in humans. I review some of the history of nutritional copper deficiency in infants and children and attempt to interpret some of the clinical manifestations in light of newly acquired information.

Meeting the Iron Needs of Infants and Young Children

Meeting the Iron Needs of Infants and Young Children

Clinical Zinc Deficiency During Zinc‐Supplemented Formula

A 2 1/2‐month old preterm infant had failure to gain weight with high caloric intake, and had generalized persistent dermatitis and mild diarrhea. The patient was being fed zinc‐supplemented cow's‐milk‐based formula (Osterfeed). High caloric intake of 8 weeks' and topical treatment of 11 weeks' duration were futile. A thorough investigation revealed low serum zinc concentration. Administration of zinc sulfate 150 mg/day resulted in brisk weight gain and complete clearing of skin lesions. The infant maintained normal levels of zinc 4 months after zinc therapy was discontinued, while being fed unmodified cow's milk and a diet of corn flour. The probability that zinc‐supplemented formulas do not meet the high zinc requirements of premature infants is raised. The importance of plasma or serum zinc examination in preterm infants with slow growth velocity or failure to gain weight despite adequate caloric intake, with or without skin lesions and diarrhea, is emphasized.