A systematic review of breast milk microbiota composition and the evidence for transfer to and colonisation of the infant gut.

The intestinal microbiota plays a major role in infant health and development. However, the role of the breastmilk microbiota in infant gut colonisation remains unclear. A systematic review was performed to evaluate the composition of the breastmilk microbiota and evidence for transfer to/colonisation of the infant gut. Searches were performed using PUBMED, OVID, LILACS and PROQUEST from inception until 18th March 2020 with a PUBMED update to December 2021. 88 full texts were evaluated before final critique based on study power, sample contamination avoidance, storage, purification process, DNA extraction/analysis, and consideration of maternal health and other potential confounders. Risk of skin contamination was reduced mainly by breast cleaning and rejecting the first milk drops. Sample storage, DNA extraction and bioinformatics varied. Several studies stored samples under conditions that may selectively impact bacterial DNA preservation, others used preculture reducing reliability. Only 15 studies, with acceptable sample size, handling, extraction, and bacterial analysis, considered transfer of bacteria to the infant. Three reported bacterial transfer from infant to breastmilk. Despite consistent evidence for the breastmilk microbiota, and recent studies using improved methods to investigate factors affecting its composition, few studies adequately considered transfer to the infant gut providing very little evidence for effective impact on gut colonisation.

Mechanisms of obesity in Prader-Willi syndrome.

Obesity is the most common cause of metabolic complications and poor quality of life in Prader-Willi syndrome (PWS). Hyperphagia and obesity develop after an initial phase of poor feeding and failure to thrive. Several mechanisms for the aetiology of obesity in PWS are proposed, which include disruption in hypothalamic pathways of satiety control resulting in hyperphagia, aberration in hormones regulating food intake, reduced energy expenditure because of hypotonia and altered behaviour with features of autism spectrum disorder. Profound muscular hypotonia prevents PWS patients from becoming physically active, causing reduced muscle movements and hence reduced energy expenditure. In a quest for the aetiology of obesity, recent evidence has focused on several appetite-regulating hormones, growth hormone, thyroid hormones and plasma adipocytokines. However, despite advancement in understanding of the genetic basis of PWS, there are contradictory data on the role of satiety hormones in hyperphagia and data regarding dietary intake are limited. Mechanistic studies on the aetiology of obesity and its relationship with disease pathogenesis in PWS are required. . In this review, we focused on the available evidence regarding mechanisms of obesity and potential new areas that could be explored to help unravel obesity pathogenesis in PWS.

Polyphenols and health: Interactions between fibre, plant polyphenols and the gut microbiota.

A high-fibre diet and one rich in fruit and vegetables have long been associated with lower risk of chronic disease. There are several possible mechanisms underpinning these associations, but one likely important factor is the production of bioactive molecules from plant-based foods by the bacteria in the colon. This links to our growing understanding of the role of the gut microbiome in promoting health. Polyphenolic-rich plant foods have been associated with potential health effects in many studies, but the bioavailability of polyphenol compounds, as eaten, is often very low. Most of the ingested molecules enter the large intestine where they are catabolised to smaller phenolic acids that may be the key bioactive effectors. Dietary fibres, present in plant foods, are also fermented by the bacteria to short-chain fatty acids, compounds associated with several beneficial effects on cell turnover, metabolism and eating behaviour. Polyphenols and fibre are often eaten together, but there is a lack of research investigating the interaction between these two groups of key substrates for the colonic bacteria. In a project funded by the Biotechnology and Biological Sciences Research Council Diet and Health Research Industry Club, we are investigating whether combining different fibres and polyphenol sources can enhance the production of bioactive phenolic acids to promote health. This could lead to improved dietary recommendations and to new products with enhanced potential health-promoting actions.

Randomised clinical study: inulin short-chain fatty acid esters for targeted delivery of short-chain fatty acids to the human colon.

BACKGROUND: Short-chain fatty acids (SCFA) produced through fermentation of nondigestible carbohydrates by the gut microbiota are associated with positive metabolic effects. However, well-controlled trials are limited in humans. AIMS: To develop a methodology to deliver SCFA directly to the colon, and to optimise colonic propionate delivery in humans, to determine its role in appetite regulation and food intake. METHODS: Inulin SCFA esters were developed and tested as site-specific delivery vehicles for SCFA to the proximal colon. Inulin propionate esters containing 0-61 wt% (IPE-0-IPE-61) propionate were assessed in vitro using batch faecal fermentations. In a randomised, controlled, crossover study, with inulin as control, ad libitum food intake (kcal) was compared after 7 days on IPE-27 or IPE-54 (10 g/day all treatments). Propionate release was determined using (13) C-labelled IPE variants. RESULTS: In vitro, IPE-27-IPE-54 wt% propionate resulted in a sevenfold increase in propionate production compared with inulin (P < 0.05). In vivo, IPE-27 led to greater (13) C recovery in breath CO2 than IPE-54 (64.9 vs. 24.9%, P = 0.001). IPE-27 also led to a reduction in energy intake during the ad libitum test meal compared with both inulin (439.5 vs. 703.9 kcal, P = 0.025) and IPE-54 (439.5 vs. 659.3 kcal, P = 0.025), whereas IPE-54 was not significantly different from inulin control. CONCLUSIONS: IPE-27 significantly reduced food intake suggesting colonic propionate plays a role in appetite regulation. Inulin short-chain fatty acid esters provide a novel tool for probing the diet-gut microbiome-host metabolism axis in humans.

Impact of eating and drinking on body composition measurements by bioelectrical impedance.

BACKGROUND: Bioelectrical impedance analysis would be a more practical tool to measure body composition in clinical settings, dietetic practice and epidemiological studies if patients/subjects did not have to fast before measurements. The present study assessed whether the ingestion of food or drink had any biologically significant effect on bioimpedance measurements and body composition by the foot-to-foot method. METHODS: Fifty-five healthy adults [30 males and 25 females; mean (SD) age 27.7 (7.1) years; mean (SD)body mass index 24 (3.8) kg m(-2)] were randomly assigned to a 2-day food trial (high-fat meal or high-carbohydrate meal) or a 2-day drink trial (water or high electrolyte drink). Body composition measurements were carried out in the fasting state, immediately after meal consumption and every 30 min for 2 h by the foot-to-foot single frequency bioimpedance technique. RESULTS: Bioimpedance increased significantly after the ingestion of food and fluid, although the changes were small. The electrolyte drink, high-fat and high-carbohydrate meals significantly increased the percentage body fat and fat mass. In all cases, the median percentage changes from baseline were approximately 1% in body fat percentage units. CONCLUSIONS: Although there were statistically significant changes in body composition estimates after food or drink consumption, these were small and within the imprecision of the impedance technique, and so are unlikely to be of clinical significance. The present study suggests that impedance measures of body fatness in clinical settings do not require strict adherence to fasting, and this should increase the opportunities for clinical application.

Glycaemic responses of staple South Asian foods alone and combined with curried chicken as a mixed meal.

BACKGROUND: The glycaemic responses of staples differ when eaten as mixed meals. We determined the glycaemic responses and glycaemic index (GI) values for common South Asian carbohydrate rich foods and the effect of adding curried chicken to them as mixed meals. METHODS: The GI and glycaemic response to staples (basmati rice, pilau rice and chapatti) and mixed meals (pilau rice with chicken curry and chapatti with chicken curry) were measured in healthy volunteers. Paired comparisons in each subject were carried out for staples and their equivalent mixed meals (n = 9). RESULTS: GI values for the mixed meals were significantly lower than the staples alone (41 and 60 for pilau rice with chicken curry and pilau rice alone, P = 0.001; 45 and 68 for chapatti with chicken curry and chapatti alone, P = 0.004). Both, pilau rice and chapatti with chicken curry had a significantly lower glycaemic response than their equivalent staples alone: incremental area under the blood glucose response curves (IAUC) 111.9 mmol min(-1 ) L(-1) for pilau rice with curry versus 162.4 mmol min(-1 ) L(-1) for pilau rice alone (P = 0.001) and IAUC 110.1 mmol min(-1 ) L(-1) for chapatti with chicken curry versus 183.6 mmol min(-1 ) L(-1) for chapatti alone (P = 0.002). CONCLUSIONS: Adding fat and protein-containing curries as part of a mixed meal to carbohydrate rich staple foods reduced glycaemic responses, and also changed the GI category.

Including a client sexual health pathway in a national youth mental health early intervention service--project rationale and implementation strategy.

Young people have higher rates of sexually transmissible infections (STIs) than the general population. Research has shown that there is a clear link between emotional distress, depression, substance abuse and sexual risk taking behaviours in young people. 'headspace' is a youth mental health early intervention service operating in more than 55 locations around Australia. This setting is ideal for accessing troubled young people who are at risk of STIs and are unlikely to attend mainstream general practice services. In 2013, a partnership was formed between headspace National Office and Hunter New England Local Health District to develop a clear clinical pathway to ensure at-risk headspace clients received sexual health assessments, advice, appropriate treatment and referral as indicated. This article describes the implementation of the pathway at the national level and a control trial to measure its efficacy. Future work will involve providing sustainable sexual health training for headspace general practitioner and allied health professionals to supplement the roll-out of the pathway in headspace centres across Australia. Support will also be provided in adapting headspace environments to encourage service utilization by Aboriginal and Torres Strait Islander and gay, lesbian, bisexual, transsexual and intersex young people.

The aetiology and impact of malnutrition in paediatric inflammatory bowel disease.

Disease-associated undernutrition of all types is very common in paediatric inflammatory bowel disease (IBD). Recent weight loss remains one of the triad of clinical manifestations and a cornerstone for the diagnosis of Crohn's disease (CD), although significantly fewer patients now present as being underweight. Recent evidence suggests that the introduction of medical treatment will quickly restore body weight, although this does not reflect concomitant changes in body composition. CD children present with features of nutritional cachexia with normal fat stores but depleted lean mass. Poor bone health, delayed puberty and growth failure are additional features that further complicate clinical management. Suboptimal nutritional intake is a main determinant of undernutrition, although activation of the immune system and secretion of pro-inflammatory cytokines exert additional independent effects. Biochemically low concentrations of plasma micronutrients are commonly reported in IBD patients, although their interpretation is difficult in the presence of an acute phase response and other indices of body stores adequacy are needed. Anaemia is a common extraintestinal manifestation of the IBD child. Iron-deficient anaemia is the predominant type, with anaemia of chronic disease second. Decreased dietary intake, as a result of decreased appetite and food aversion, is the major cause of undernutrition in paediatric IBD. Altered energy and nutrient requirements, malabsorption and increased gastrointestinal losses are additional factors, although their contribution to undernutrition in paediatric CD needs to be studied further.

Vitamin A provision for preterm infants: are we meeting current guidelines?

BACKGROUND: Preterm infants have reduced liver stores of vitamin A at birth compared to term born infants. Current guidelines recommend an intake of 700-1500 IU/kg/day vitamin A, and there is evidence to support higher doses for infants with significant lung disease. The importance of appropriate early nutrition for preterm infants is increasingly becoming apparent. OBJECTIVES: To examine whether preterm infants admitted to a UK neonatal unit received the currently recommended amounts of vitamin A during the first 4 weeks of life, and to identify the feeding patterns associated with optimal vitamin A intake. DESIGN: Retrospective case note review. SETTING: UK tertiary neonatal unit. POPULATION: 36 preterm infants with a median gestation of 30 weeks (range 26-33 weeks) and median birth weight of 1305 g (range 880-1800 g). MAIN OUTCOME MEASURE: Mean daily total intake of vitamin A in each of the first 4 weeks of life. RESULTS: Despite a policy of introducing intravenous lipid supplemented with fat soluble vitamins on day 2, only four infants (11%) consistently met the recommended daily intake of vitamin A during the first 2 weeks of life. Adequacy of vitamin A intake in the first 2 weeks of life was not predicted by gestation or pattern of feeding. CONCLUSION: Recommendations for intravenous vitamin A supplementation in parenterally fed preterm infants require revision. Intravenous lipid with added fat soluble vitamins should be started as soon as possible after birth, and consideration given to early oral vitamin A supplementation in those infants tolerant of enteral feeds.

Infant feeding and allergy prevention: a review of current knowledge and recommendations. A EuroPrevall state of the art paper.

The relationship between infant feeding patterns and the later development of food allergies has been the focus of much debate and research over the last decade. National recommendations have been made by many countries on how to feed infants to reduce the risk of food allergy but due to the lack of firm evidence the recommendations differ widely. This review has been developed as part of EuroPrevall, a European multicentre research project funded by the European Union, to document the differing feeding recommendations made across Europe, to investigate the current evidence base for any allergy prevention feeding recommendations and to identify areas where further research is needed. This review will also provide information which, when combined with the infant feeding data collected as part of EuroPrevall, will give an indication of compliance to national feeding guidelines which can be utilised to assess the effectiveness of current dissemination and implementation strategies.

Effect of advice to increase carbohydrate and reduce fat intake on dietary profile and plasma lipid concentrations in healthy postmenopausal women.

BACKGROUND: The current dietary guidelines advise an increase in carbohydrate intake. However, there is concern regarding the effect this may have on coronary heart disease (CHD) risk, in particular in postmenopausal women, in light of the knowledge that raised triacylglycerol (TAG) may pose a stronger risk for CHD in this group. AIM: To evaluate the effect of advice to increase carbohydrate intake to 50% of energy intake as part of advice to follow current dietary guidelines on the dietary profile, including dietary glycaemic index (GI) and plasma lipids in healthy postmenopausal women. METHODS: Twelve healthy postmenopausal women (56 +/- 6.5 years) took part in the study. Habitual diet was assessed by a 7-day weighed intake. On the basis of the results, subjects were advised to increase their carbohydrate intake to comply with the current dietary guidelines. Subjects were asked to follow this diet for 4 weeks, in a free-living situation. Fasting blood samples were obtained at baseline and after 1 and 4 weeks. RESULTS: There was a significant decrease in body mass index (BMI; p < 0.05) after 4 weeks. There was a significant increase in fasting TAG concentrations after 1 week (p < 0.05), and the high-density lipoprotein (HDL) cholesterol concentration was significantly decreased (p < 0.05) after 1 and 4 weeks. The subjects significantly increased their percentage of energy from carbohydrates and starch (p < 0.05 and p < 0.01, respectively) after 1 week, and their percentage of energy from starch after 4 weeks (p < 0.05). Dietary GI was significantly increased (p < 0.05) after 1 and 4 weeks. Fruit and vegetable intake was significantly increased after 1 week (p < 0.01), as was fruit intake alone (p < 0.05), and there was a significant increase (p < 0.05) in the 'antioxidant power' as measured by the ferric reducing ability of plasma assay. CONCLUSION: In postmenopausal women, following the UK dietary guidelines resulted in changes in the lipid profile that were more likely to favour an increased risk of CHD, as TAG concentrations were increased and HDL cholesterol concentrations were reduced. However, in addition, we found a significant reduction in BMI and a significant increase in the 'antioxidant power' of plasma, which should benefit health.

Dietary modifications, nutritional supplements and alternative medicine in paediatric patients with inflammatory bowel disease.

BACKGROUND: Data on use of complementary and alternative medicine in children with inflammatory bowel disease are scarce. AIM: To assess prevalence, predictors and parental attitude to the use of complementary and alternative medicine in a paediatric population with inflammatory bowel disease in the west of Scotland. METHODS: Questionnaire survey encompassing alternative therapists, nutritional supplements and dietary modifications used in the management of inflammatory bowel disease was used. Demographics, disease and treatment data were also collected. RESULTS: 86 guardians completed the survey. 61% had used at least one type and 37% were using complementary and alternative medicine recently. The most common types were probiotics (44%) and dairy-free diet (28%). Higher parental education and young parental age were predictors of complementary and alternative medicine use. An increased number of oral steroid courses and prior use of complementary and alternative medicine for other health reasons were associated with use of alternative therapists. Personal recommendation and to complement conventional medicine were the main reasons for using complementary and alternative medicine. 48% judged complementary and alternative medicine at least partially effective. 86% agreed that doctors should be supportive of use. 89% would give complementary and alternative medicine to their children. CONCLUSIONS: Use of complementary and alternative medicine was higher in children with IBD than in adults with the same disease. The gastrointestinal nature of the disease could explain the high use of nutritional supplements and dietary modifications in this survey.

Parental perceptions of feeding practices in five European countries: an exploratory study.

OBJECTIVE: To gain an insight into parental perceptions of infant feeding practices in five European countries. DESIGN: An exploratory investigation using focus group discussions. Various aspects addressed included social and cultural setting for the consumption of food, infant feeding practice and behaviour, consumer health awareness and sources of information, and attitudes towards a healthy infant diet. SETTING: Focus group participants were recruited from centres in five countries, Germany, Italy, Scotland, Spain and Sweden, with three focus groups being conducted in each centre. SUBJECTS: A total of 108 parents with infants up to the age of 12 months participated in focus group discussions across these centres. METHODS: Focus groups were conducted with participants from centres in five countries. RESULTS: The majority of parents in this study chose to initiate breastfeeding and prepare infant food at home. Parents did not strictly adhere to infant feeding guidelines when introducing complementary foods into their infant's diets. There were cross-cultural differences in sources of information on infant feeding practice with the paediatrician in Germany, Italy and Spain. The health visitor in Scotland and the child welfare clinics in Sweden were the most popular sources. CONCLUSIONS: A number of cultural differences and similarities in attitudes towards infant feeding practice were revealed. This makes European wide approaches to promoting healthy infant feeding difficult as different infant feeding practices are influenced not only by parental perceptions but also by advice from health professionals and feeding guidelines. Further data need to be available on parents' attitudes and beliefs towards infant feeding practice to investigate further the rationale for differing beliefs and attitudes towards infant feeding practice. SPONSORSHIP: EU Fifth Framework QLRT 2002 02606.

Influences of vermicomposts on field strawberries: part 2. Effects on soil microbiological and chemical properties.

The effects of applications of food waste and paper waste vermicomposts on some soil chemical and biological properties were evaluated in field plots planted with strawberries. Six-week old strawberries (Fragaria ananasa, var. Chandler) were transplanted into 4.5 m(2) raised beds under a plastic tunnel structure measuring 9.14 x 14.6 x 3.6 m. Vermicompost were applied at rates of 5 or 10 t ha(-1) supplemented with inorganic fertilizers to balance fertilizer recommendations for strawberries of 85-155-125 kg NPK ha(-1). Effects of vermicomposts on strawberry growth and yields have been reported previously [Arancon, N.Q., Edwards C.A., Bierman P., Welch, C., Metzger, J.D., 2004. The influence of vermicompost applications to strawberries: Part 1. Effects on growth and yield. Bioresource Technology 93:145-153]. Total extractable N, NH(4)-N, NO(3)-N and orthophosphates did not differ significantly between treatments, except on the last sampling date (harvest date) in which significantly greater amounts of NH(4)-N, NO(3)-N and orthophosphates (P

Out of the Smokescreen: does an anti-smoking advertisement affect young women's perception of smoking in movies and their intention to smoke?

OBJECTIVE: To evaluate the effect of an anti-smoking advertisement on young women's perceptions of smoking in movies and their intention to smoke. SUBJECTS/ SETTING: 2038 females aged 12-17 years attending cinemas in New South Wales, Australia. DESIGN/ INTERVENTION: Quasi-experimental study of patrons, who were surveyed after having viewed a movie at their local cinema. The control group was surveyed during week 1 and the intervention group, during week 2. Before seeing the movie in week 2, a 30 second anti-smoking advertisement was shown, which featured a well known female actor drawing attention to the prevalence of smoking in movies. OUTCOMES: Attitude of current smokers and non-smokers to smoking in the movies; intention of current smokers and non-smokers to be smoking in 12 months time. RESULTS: Among non-smokers, 48.2% of the intervention subjects thought that the smoking in the movie they viewed was "not OK" compared with 28.3% of the control subjects (p < 0.0001). However, there was no difference among smokers in the intervention (26.4%) and control (16.9%) groups (p = 0.28). A higher percentage of current smokers in the intervention group indicated they were unlikely to smoke in 12 months time (47.8%) than smokers in the control condition (31.9%) (p = 0.03). For non-smokers, there was no difference in smoking intentions between conditions, with 95% saying they would be unlikely to be smoking in 12 months time. CONCLUSIONS: This "real world" study suggests that placing an anti-smoking advertisement before movies containing smoking scenes can help to "immunise" young women against the influences of film stars smoking.

Influences of vermicomposts on field strawberries: 1. effects on growth and yields.

Vermicomposts processed commercially from food wastes and paper wastes were applied, to 4.5 m(2) field plots, under high plastic hoop tunnels, at rates of 5 or 10 tha(-1) to evaluate their effects on the growth and yields of strawberries (Fragaria ananasa) var. 'Chandler'. The vermicomposts were incorporated into the top 10 cm of soil and supplemented, based on chemical analyses, with amounts of inorganic NPK fertilizers calculated to equalize the initial fertilizer rates of 85-155-125 kgha(-1) NPK applied to the inorganic fertilizer plots. All treatments were replicated four times, in a completely randomized design, at two field sites on Doles silt loam or Hoytville silty clay loam at Piketon and Fremont, Ohio, respectively. Vermicompost applications increased strawberry growth and yields significantly; including increases of up to 37% in leaf areas, 37% in plant shoot biomass, 40% in numbers of flowers, 36% in numbers of plant runners and 35% in marketable fruit weights. These responses seemed not to be dose-dependent, since strawberries at one site grew fastest and yielded most in response to the 10 tha(-1) vermicompost application rate, whereas they responded positively and similarly to both the 5 and 10 tha(-1) rates of applications at the other site. These responses could not have been mediated by availability of macronutrients, since all plots were supplemented with inorganic fertilizers, to equalize macronutrient inputs for all treatments, but based on other research in our laboratory could have been due to production of plant growth regulators by microorganisms during vermicomposting.

Relationship between birth weight and adult lung function: controlling for maternal factors.

BACKGROUND: There is conflicting evidence on the "fetal origins hypothesis" of association between birth weight and adult lung function. This may be due to failure to control for confounding maternal factors influencing birth weight. In the present study access to birth details for adults aged 45-50 years who were documented as children to have asthma, wheezy bronchitis, or no respiratory symptoms provided an opportunity to investigate this association, controlling for maternal factors. METHODS: In 2001 the cohort was assessed for current lung function, smoking status, and respiratory symptoms. Birth details obtained from the Aberdeen Maternity and Neonatal Databank recorded birth weight, gestation, parity, and mother's age and height. RESULTS: 381 subjects aged 45-50 years were traced and tested for lung function; 323 (85%) had birth details available. A significant linear trend (p<0.01) was observed between birth weight and current forced expiratory volume in 1 second (FEV(1)) and forced vital capacity (FVC) values (adjusted for height, age, sex, weight, deprivation category (Depcat), childhood group, and smoking status). This trend remained significant after adjusting birth weight for gestation, parity, sex, mother's height and weight (p = 0.01). The relationship between birth weight and FEV(1) and FVC remained significant when adjusted for smoking history. There was no association between birth weight and current wheezing symptoms. CONCLUSION: There is a positive linear trend between birth weight, adjusted for maternal factors, and lung function in adulthood. The strength of this association supports the "fetal origins hypothesis" that impairment of fetal growth is a significant influence on adult lung function.

The DNA sequence and analysis of human chromosome 6.

Chromosome 6 is a metacentric chromosome that constitutes about 6% of the human genome. The finished sequence comprises 166,880,988 base pairs, representing the largest chromosome sequenced so far. The entire sequence has been subjected to high-quality manual annotation, resulting in the evidence-supported identification of 1,557 genes and 633 pseudogenes. Here we report that at least 96% of the protein-coding genes have been identified, as assessed by multi-species comparative sequence analysis, and provide evidence for the presence of further, otherwise unsupported exons/genes. Among these are genes directly implicated in cancer, schizophrenia, autoimmunity and many other diseases. Chromosome 6 harbours the largest transfer RNA gene cluster in the genome; we show that this cluster co-localizes with a region of high transcriptional activity. Within the essential immune loci of the major histocompatibility complex, we find HLA-B to be the most polymorphic gene on chromosome 6 and in the human genome.

Starch fermentation by faecal bacteria of infants, toddlers and adults: importance for energy salvage.

OBJECTIVE: Little is known of the degree to which the colon salvages energy through starch fermentation in young children. Using a simulated colonic environment, we aimed to account for the fate of fermented raw and cooked starch in two groups of young children and in adults. DESIGN: A slurry was prepared from faecal samples from six infants (7-10 months), six toddlers (16-21 months) and seven adults (24-56 y). Each slurry was anaerobically incubated with raw or cooked maize starch in MacCartney bottles in a shaking water bath. Parallel incubations were stopped at 4 and 24 h. The headspace gas volume was analysed for CO(2) and methane. The culture supernatant was analysed for short-chain fatty acids (SCFA), lactate and residual starch. RESULTS: Different patterns of fermentation were seen at 4 and 24 h. For raw starch, the production of SCFA decreased with subject age at 4 h but not at 24 h. With both substrates at 4 h, toddler stools produced significantly more CO(2) than infants or adults, but there were no statistical differences at 24 h. Methane was detected in three adults only. Lactate was detected mainly at 4 h in children. CONCLUSIONS: The results suggest that fermentation, particularly of raw starch, is a more rapid process in young children than in adults. A highly efficient energy salvage process may occur in the colon of young children.

Dietary fibre in infancy and childhood.

There is very little evidence for the effects of dietary fibre in young children and current dietary guidelines are based on assumptions and data extrapolated from studies in adults. The first years of life may be critical for the establishment of a healthy colonic microflora, as well as good eating habits. The lack of clear and well-founded guidelines for the intake of dietary fibre in childhood may hinder both factors. The fears that a high-fibre diet in children < 5 years of age will lead to growth faltering and mineral imbalance are not well supported in the literature, especially for children in the developed world. Indeed, with the rising levels of obesity, fibre intake may be of benefit in reducing energy intake. A low-fibre diet may also be implicated in the aetiology of childhood constipation and appendicitis. The latest proposals for the definition of dietary fibre include oligosaccharides, which may act as prebiotics. There are potential health benefits of including oligosaccharides in the diets of infants and children, but more research is needed to consider the long-term effects. The immature intestine of the infant may also result in a greater amount of starch entering the colon during weaning, and this starch would now be considered dietary fibre under the new definitions. Much new research is needed to allow adequate recommendations for the intake of dietary fibre in childhood based on data collected in appropriate age-groups.